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Seizure control in patients with idiopathic generalized epilepsies: EEG determinants of medication response
Authors:Jerzy P. Szaflarski  Christopher J. Lindsell  Tarek Zakaria  Christi Banks  Michael D. Privitera
Affiliation:1. Department of Gynecology and Obstetrics, Emory University, United States;2. Department of Surgery, University of Alabama at Birmingham, United States;3. Department of Neurology, Emory University, United States;4. Department of Neurology, University of Alabama at Birmingham, United States;5. Division of Preventive Medicine, University of Alabama at Birmingham, United States;1. Epilepsy Foundation of America, Landover, MD, United States;2. Beth Israel Deaconess Medical Center, Boston, MA, United States;3. Montefiore Medical Center, Bronx, NY, United States;4. Indiana University School of Nursing, Indianapolis, IN, United States;5. UCLA Seizure Disorder Center, Los Angeles, CA, United States;6. The Ohio State University, Columbus, OH, United States;7. Virginia Commonwealth University Children''s Pavilion, Richmond, VA, United States;8. Santilli Global, LLC, Sunnyvale, CA, United States;1. Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA;2. UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA;3. Departments of Neurology and Psychiatry, Rhode Island Hospital, Brown University, Providence, RI, USA
Abstract:In a minority of patients with idiopathic generalized epilepsies (IGEs), seizures continue despite appropriate treatment. We sought to determine the clinical and EEG factors associated with medication response in these patients. All patients with IGEs evaluated by epilepsy specialists between 17 November 2008 and 16 November 2009 were included. We collected information on seizure freedom (dependent variable), EEG asymmetries, response to valproic acid (VPA), MRI characteristics, medication use, demographics, and seizure history (predictors). We identified 322 patients with IGEs; 45 (14%) were excluded from analyses because they had always had a normal EEG (N = 26), there were no EEG data (N = 3), or they were non-compliant with medication (N = 26). Patients with juvenile myoclonic epilepsy were more likely to respond to VPA than were patients with other IGEs, and VPA response was associated with seizure freedom. When EEG characteristics were considered, presence of any focal EEG abnormalities (focal slowing, focal epileptiform discharges, or both) was associated with decreased odds of seizure freedom. These findings suggest that patients with IGEs with poor seizure control may have atypical IGEs with possibly focal, for example, frontal, rather than thalamic onset.
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