Abstracts

Rationale: Epilepsy is one of the world’s most common neurologic disorders that affects more than 50 million people worldwide and represents a public health problem as more than 20 million of them continue to have seizures that are not controlled satisfactorily with antiepileptic drugs. Refractory seizures leads to a psychosocial impairment, interfering directly and negatively in patients' quality of life. Recent studies have shown that surgical treatment to drug-resistant epilepsy, respecting strict indication criteria, may be an efficient alternative for the control of seizures and allows to provide a biopsychosocial care so the patient can be rehabilitated and able to perform their daily life activities. (Alvarenga et al., 2007; Ramey et al., 2013). This study aims to present the epidemiological and postoperative profiles of patients surgically treated for refractory epilepsy at Angelina Caron Hospital, in order to provide comparable information with data described in literature and, thus, contribute to improve its medical care.  Methods: Through a retrospective data based study of 63 medical records of patients submitted to surgical treatment for refractory epilepsy, performed from July 2010 to November 2016 at Angelina Caron Hospital located in Campina Grande do Sul city in the state of Paraná, Brazil, it was aimed to analyse the postoperative data and classifying it according to the Engel scale. A descriptive analysis was performed through frequency calculations and central tendency measures, with the respective 95% confidence intervals.  Results: Epidemiological data revealed a predominance of female patients (55%). The most common etiologic diagnosis was mesial temporal sclerosis (78.5%) followed by brain tumor (21.4%). Regarding the previous pharmacological treatment, 60% were on antiepileptic drugs for more than 20 years. The mean age at the time of surgery was 34,5 years. Seven cases of immediate postoperative complications (12.5%) were recorded (transient weakness or dysphasia and visual field deficits, cerebral hemorrhage). By follow-up records, 39 patients (69.6%) presented an Engel I classification (free of disabiling seizures), 7 of them (12.5%) had an Engel II classification (rare disabiling seizures), 6 patients (10.7%) had an Engel III rating (worthwhile improvement) and 4 (7.1%) presented a classification IV (no worthwhile improvement) - this last group was composed of 3 patients with brain tumor and 1 patient with temporal mesial sclerosis. Among the group of patients wich had remunerated activity, 60.4% reported returning to work on postoperatively and 85.7% of the total sample described an evident improvement in the quality of life after surgical treatment, corresponding to the expressive majority of the sample.  Conclusions: Surgical treatment is well-established option for the management of refractory epilepsy. The results observed in the present study allows to conclude that the surgery was effective for the majority of patients with refractory epilepsy treated at Angelina Caron Hospital, whose epidemiological profile is similar to that described in the world’s literature. Through reports of return to work activity, reestablishment of daily routine and improvement of self-care in most of the sample, it was possible to observe an improvement in patients' overall quality of life. Thus, surgical treatment of refractory epilepsy may provide not only more effective control of disabling seizures, but also social reintegration of the individual previously limited by his disease. Regarding the cost-effectiveness of this modality of treatment, there is strong evidence that surgery for epilepsy may contribute to a significant reduction in health care expenditures.  Funding: None