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Abstract
Objective To identify clinical and EEG biomarkers of drug resistance in adults with idiopathic generalized epilepsy.
Methods We conducted a case-control study consisting of a discovery cohort and a replication cohort independently assessed at 2 different centers. In each center, patients with the idiopathic generalized epilepsy phenotype and generalized spike-wave discharges on EEG were classified as drug-resistant or drug-responsive. EEG changes were classified into predefined patterns and compared between the 2 groups in the discovery cohort. Factors associated with drug resistance in multivariable analysis were tested in the replication cohort.
Results The discovery cohort included 85 patients (29% drug-resistant and 71% drug-responsive). Their median age at assessment was 32 years and 50.6% were female. Multivariable analysis showed that higher number of seizure types ever experienced (3 vs 1: odds ratio [OR] = 31.1, 95% confidence interval [CI]: 4.5–214, p < 0.001; 3 vs 2: OR = 14.6, 95% CI: 2.3–93.1, p = 0.004) and generalized polyspike train (burst of generalized rhythmic spikes lasting less than 1 second) during sleep were associated with drug resistance (OR = 10.8, 95% CI: 2.4–49.4, p = 0.002). When these factors were tested in the replication cohort of 80 patients (27.5% drug-resistant and 72.5% drug-responsive; 71.3% female; median age 27.5 years), the proportion of patients with generalized polyspike train during sleep was also higher in the drug-resistant group (OR = 4.0, 95% CI: 1.35–11.8, p = 0.012).
Conclusion Generalized polyspike train during sleep may be an EEG biomarker for drug resistance in adults with idiopathic generalized epilepsy.
Glossary
- AED=
- antiepileptic drug;
- CAE=
- childhood absence epilepsy;
- CI=
- confidence interval;
- GABA=
- γ-aminobutyric acid;
- GLVFA=
- generalized low-voltage fast activity;
- GPFA=
- generalized paroxysmal fast activity;
- GPT=
- generalized polyspike train;
- GTCS=
- generalized tonic-clonic seizures;
- GTCSA=
- generalized tonic-clonic seizures alone;
- IGE=
- idiopathic generalized epilepsy;
- IQR=
- interquartile range;
- JAE=
- juvenile absence epilepsy;
- JME=
- juvenile myoclonic epilepsy;
- LGS=
- Lennox-Gastaut syndrome;
- N1=
- stage 1 sleep;
- N2=
- stage 2 sleep;
- OR=
- odds ratio;
- PSW=
- polyspike-wave;
- SW=
- spike-wave
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
- Received February 18, 2018.
- Accepted in final form August 1, 2018.
- © 2018 American Academy of Neurology
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