Ioannis Karakis1, Jay S Pathmanathan2, Richard Chang2, E Francis Cook3, Sydney S Cash2, Andrew J Cole2. 1. Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA. Electronic address: ioannis.karakis@emory.edu. 2. MGH Epilepsy Service, Harvard Medical School, Boston, MA, USA. 3. Harvard School of Public Health, Boston, MA, USA.
Abstract
OBJECTIVE: Previous studies based solely on visual EEG analysis reported equivocal results regarding an association of pharmaco-resistance with EEG asymmetries in genetic generalized epilepsies (GGE). We addressed this issue by applying both visual and quantitative methods to the pretreatment EEG of GGE patients. METHODS: Socio-demographic/disease characteristics and response to treatment/discontinuation trial for these patients were recorded at 6months and at last follow up. The first EEG was retrospectively, blindly, and visually assessed for focal slowing, focal discharges and also quantitatively analyzed for amplitude or latency asymmetries of generalized discharges. Association between these variables and development of drug-resistance was evaluated. RESULTS: Out of 51 subjects, 40% had some type of EEG asymmetry by visual, 37% by quantitative and 54% by combined analysis. Drug-resistance was identified in 52% of patients after 6months and in 24% at the end of the follow up period (∼4.2years). 27% of patients underwent a discontinuation trial; 43% unsuccessfully. There was no association between baseline EEG asymmetries of any type and refractoriness to medical therapy, regardless of analytical method used. CONCLUSIONS: In a carefully selected cohort of medication-naïve GGE patients, visual and quantitative asymmetries in the first EEG were not associated with the development of pharmaco-resistance. SIGNIFICANCE: These findings do not provide support for utilization of EEG asymmetries as a prognostic tool in GGE.
OBJECTIVE: Previous studies based solely on visual EEG analysis reported equivocal results regarding an association of pharmaco-resistance with EEG asymmetries in genetic generalized epilepsies (GGE). We addressed this issue by applying both visual and quantitative methods to the pretreatment EEG of GGEpatients. METHODS: Socio-demographic/disease characteristics and response to treatment/discontinuation trial for these patients were recorded at 6months and at last follow up. The first EEG was retrospectively, blindly, and visually assessed for focal slowing, focal discharges and also quantitatively analyzed for amplitude or latency asymmetries of generalized discharges. Association between these variables and development of drug-resistance was evaluated. RESULTS: Out of 51 subjects, 40% had some type of EEG asymmetry by visual, 37% by quantitative and 54% by combined analysis. Drug-resistance was identified in 52% of patients after 6months and in 24% at the end of the follow up period (∼4.2years). 27% of patients underwent a discontinuation trial; 43% unsuccessfully. There was no association between baseline EEG asymmetries of any type and refractoriness to medical therapy, regardless of analytical method used. CONCLUSIONS: In a carefully selected cohort of medication-naïve GGEpatients, visual and quantitative asymmetries in the first EEG were not associated with the development of pharmaco-resistance. SIGNIFICANCE: These findings do not provide support for utilization of EEG asymmetries as a prognostic tool in GGE.
Authors: Jerzy P Szaflarski; Mark DiFrancesco; Thomas Hirschauer; Christi Banks; Michael D Privitera; Jean Gotman; Scott K Holland Journal: Epilepsy Behav Date: 2010-06-26 Impact factor: 2.937
Authors: Tracy A Glauser; Avital Cnaan; Shlomo Shinnar; Deborah G Hirtz; Dennis Dlugos; David Masur; Peggy O Clark; Edmund V Capparelli; Peter C Adamson Journal: N Engl J Med Date: 2010-03-04 Impact factor: 91.245
Authors: Jerzy P Szaflarski; Christopher J Lindsell; Tarek Zakaria; Christi Banks; Michael D Privitera Journal: Epilepsy Behav Date: 2010-03-12 Impact factor: 2.937
Authors: Anne T Berg; Samuel F Berkovic; Martin J Brodie; Jeffrey Buchhalter; J Helen Cross; Walter van Emde Boas; Jerome Engel; Jacqueline French; Tracy A Glauser; Gary W Mathern; Solomon L Moshé; Douglas Nordli; Perrine Plouin; Ingrid E Scheffer Journal: Epilepsia Date: 2010-02-26 Impact factor: 5.864
Authors: Friederike Moeller; Hartwig R Siebner; Stephan Wolff; Hiltrud Muhle; Oliver Granert; Olav Jansen; Ulrich Stephani; Michael Siniatchkin Journal: Epilepsia Date: 2008-04-24 Impact factor: 5.864
Authors: Anthony G Marson; Asya M Al-Kharusi; Muna Alwaidh; Richard Appleton; Gus A Baker; David W Chadwick; Celia Cramp; Oliver C Cockerell; Paul N Cooper; Julie Doughty; Barbara Eaton; Carrol Gamble; Peter J Goulding; Stephen J L Howell; Adrian Hughes; Margaret Jackson; Ann Jacoby; Mark Kellett; Geoffrey R Lawson; John Paul Leach; Paola Nicolaides; Richard Roberts; Phil Shackley; Jing Shen; David F Smith; Philip E M Smith; Catrin Tudur Smith; Alessandra Vanoli; Paula R Williamson Journal: Lancet Date: 2007-03-24 Impact factor: 79.321
Authors: Jerzy P Szaflarski; Seongtaek Lee; Jane B Allendorfer; Tyler E Gaston; Robert C Knowlton; Sandipan Pati; Lawrence W Ver Hoef; Georg Deutsch Journal: Med Sci Monit Date: 2016-06-10