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Abstract
Medically refractory seizures constitute the magnitude of the problem among our epileptic patients. Medically refractory seizures produce many psychological and social difficulties. Recurrent seizures impair socialization and psychological development during formative years and may lead to an inability to obtain an education, gainful employment, or driving privileges. Despite advances in anti-epileptic drug (AED) therapy and epilepsy surgery in recent years, intractable or refractory epilepsy remains a major clinical problem.Neuroimaging is important for those patients who have medically intractable seizures. CT can accurately detect hemorrhage, infarctions, gross malformations, ventricular system pathologies, and lesions with underlying calcification. MRI is the most sensitive and useful examination to demonstrate structural abnormalities in patients with partial or localizationrelated epilepsy, temporal lobe epilepsy, neoplastic lesions, vascular lesions,and developmental anomaly This study was conducted on 20 medically refractory epileptic patients out of 150 epileptic patients (12.5%) on antiepileptic drug therapy one or more) attending the neurology unit, pediatric department, Menoufiya University Hospital. They were referred for CT and or MRI study of the brain to detect possible causes for intractability. The studied patients included 10 males and 10 females. Their ages ranged between 1-11 years from the results of CT and /or MRI studies of the patients, we were able to reach possible etiologies to explain the causes of their seizures. Two patients (10%) were diagnosed as having idiopathic refractory epilepsy, as CT scan and MRI of the brain revealed normal brain size and ventricular system. Eighteen patients (90%) were diagnosed as having secondary refractory epilepsy, as CT scan and MRI of the brain revealed underlying brain lesions as :-Seven patients (35%) had post anoxic cerebral palsy .The following lesions were detected, diffuse cortical atrophy , ventricular system dilatation .One of the 7 patients, had signs of Leuckodystrophy in MRI Four patients (20%) were diagnosed as having congenital lesions; - one patient had agenesis of corpus callosum, another had lissencephaly and pachygyria , the 3rd patient had advanced Dandy Walker malformation and the 4th had Sturge Weber syndrome. Three patients (35%) were diagnosed as having post-encephalitic sequale: The three patients had diffuse cortical atrophy and ventricular system dilatation. One patient (5%) was diagnosed as having neurodegenerative brain disease. Three patients (35%) were diagnosed as having space occupying lesions (brain tumors).