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

Prognostic factors in patients with refractory idiopathic generalized epilepsy.

Author information

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.

KEYWORDS:

Drug-resistance; Generalized epilepsy; Lifestyle; Prognosis

[Indexed for MEDLINE]

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