A Gomez-Ibañez1, R S McLachlan2, S M Mirsattari3, D C Diosy4, J G Burneo5. 1. Epilepsy Program, Department of Clinical Neurological Sciences, London Health Sciences Centre,Western University. 339 Windermere Road, London, N6A5A5 ON, Canada; Epilepsy Unit, Hospital Universitario y Politecnico La Fe, Avda. Fernando Abril Martorell, 106. 46026 Valencia, Spain. Electronic address: asiergomez81@gmail.com. 2. Epilepsy Program, Department of Clinical Neurological Sciences, London Health Sciences Centre,Western University. 339 Windermere Road, London, N6A5A5 ON, Canada. Electronic address: Rick.McLachlan@lhsc.on.ca. 3. Epilepsy Program, Department of Clinical Neurological Sciences, London Health Sciences Centre,Western University. 339 Windermere Road, London, N6A5A5 ON, Canada. Electronic address: smirsat2@uwo.ca. 4. Epilepsy Program, Department of Clinical Neurological Sciences, London Health Sciences Centre,Western University. 339 Windermere Road, London, N6A5A5 ON, Canada. Electronic address: David.Diosy@lhsc.on.ca. 5. Epilepsy Program, Department of Clinical Neurological Sciences, London Health Sciences Centre,Western University. 339 Windermere Road, London, N6A5A5 ON, Canada. Electronic address: jburneo2@uwo.ca.
Abstract
OBJECTIVE: Idiopathic generalized epilepsy (IGE) is an epileptic condition with good response to antiepileptic drugs (AED). Major syndromes are epilepsy with generalized tonic-clonic seizures (GTCS) alone, absence epilepsy and juvenile myoclonic epilepsy. However, clinical practice shows drug-resistant patients. Endpoint is to identify clinical features related with refractoriness in IGE and in its each individual syndrome. METHODS: We retrospectively collected 279 consecutive patients with IGE assessed in the Epilepsy Clinic of our institution. We defined drug-resistant epilepsy as a failure of adequate trials of 2 tolerated and appropriately chosen and used AED schedules. We classified patients in two groups: drug-resistant and drug-responsive. Clinical features were compared among these groups, in the whole IGE group as well as in each syndrome. RESULTS: There were 122 drug-resistant, 105 drug- responsive; 52 were undefined and excluded from the analysis. After multivariate analysis, early seizures onset (age <13), long-time epilepsy, several generalized seizure types, status epilepticus, EEG with generalized epileptiform activity, mainly polyspikes, and side effects with AED brought up as poor outcome factors. Additionally, 50.6% identified modifiable seizure triggers. Regarding syndromes, epilepsy with generalized tonic-clonic seizures alone had the same factors except several seizure types; presence of additional GTCS, polyspikes, history of AED side effects and psychiatric disorder were poor factors for absence epilepsy; only psychiatric comorbidity revealed significance in juvenile myoclonic epilepsy. SIGNIFICANCE: Refractoriness in IGE and its major syndromes is associated with clinical and electrographic parameters. Moreover, lifestyle advices from neurologists to the patients might help them to achieve a better seizure control.
OBJECTIVE:Idiopathic generalized epilepsy (IGE) is an epileptic condition with good response to antiepileptic drugs (AED). Major syndromes are epilepsy with generalized tonic-clonic seizures (GTCS) alone, absence epilepsy and juvenile myoclonic epilepsy. However, clinical practice shows drug-resistant patients. Endpoint is to identify clinical features related with refractoriness in IGE and in its each individual syndrome. METHODS: We retrospectively collected 279 consecutive patients with IGE assessed in the Epilepsy Clinic of our institution. We defined drug-resistant epilepsy as a failure of adequate trials of 2 tolerated and appropriately chosen and used AED schedules. We classified patients in two groups: drug-resistant and drug-responsive. Clinical features were compared among these groups, in the whole IGE group as well as in each syndrome. RESULTS: There were 122 drug-resistant, 105 drug- responsive; 52 were undefined and excluded from the analysis. After multivariate analysis, early seizures onset (age <13), long-time epilepsy, several generalized seizure types, status epilepticus, EEG with generalized epileptiform activity, mainly polyspikes, and side effects with AED brought up as poor outcome factors. Additionally, 50.6% identified modifiable seizure triggers. Regarding syndromes, epilepsy with generalized tonic-clonic seizures alone had the same factors except several seizure types; presence of additional GTCS, polyspikes, history of AED side effects and psychiatric disorder were poor factors for absence epilepsy; only psychiatric comorbidity revealed significance in juvenile myoclonic epilepsy. SIGNIFICANCE: Refractoriness in IGE and its major syndromes is associated with clinical and electrographic parameters. Moreover, lifestyle advices from neurologists to the patients might help them to achieve a better seizure control.