Prognostic factors in patients with refractory idiopathic generalized epilepsy

Epilepsy Res. 2017 Feb;130:69-73. doi: 10.1016/j.eplepsyres.2017.01.011. Epub 2017 Jan 28.

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.

Keywords: Drug-resistance; Generalized epilepsy; Lifestyle; Prognosis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age of Onset
  • Aged
  • Anticonvulsants / adverse effects
  • Anticonvulsants / therapeutic use
  • Drug Resistant Epilepsy / diagnosis*
  • Drug Resistant Epilepsy / drug therapy
  • Drug Resistant Epilepsy / physiopathology
  • Electroencephalography
  • Epilepsy, Generalized / diagnosis*
  • Epilepsy, Generalized / drug therapy
  • Epilepsy, Generalized / physiopathology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Prognosis
  • Retrospective Studies
  • Status Epilepticus / diagnosis
  • Status Epilepticus / drug therapy
  • Status Epilepticus / physiopathology
  • Treatment Outcome
  • Young Adult

Substances

  • Anticonvulsants

Supplementary concepts

  • Epilepsy, Idiopathic Generalized