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. 2014 Feb;125(2):263-9.
doi: 10.1016/j.clinph.2013.07.028. Epub 2013 Oct 1.

Prognostic value of EEG asymmetries for development of drug-resistance in drug-naïve patients with genetic generalized epilepsies

Ioannis Karakis  1 , Jay S Pathmanathan  2 , Richard Chang  2 , E Francis Cook  3 , Sydney S Cash  2 , Andrew J Cole  2
Affiliations

Prognostic value of EEG asymmetries for development of drug-resistance in drug-naïve patients with genetic generalized epilepsies

Ioannis Karakis et al. Clin Neurophysiol. 2014 Feb.

Abstract

Objective: Previous studies based solely on visual EEG analysis reported equivocal results regarding an association of pharmaco-resistance with EEG asymmetries in genetic generalized epilepsies (GGE). We addressed this issue by applying both visual and quantitative methods to the pretreatment EEG of GGE patients.

Methods: Socio-demographic/disease characteristics and response to treatment/discontinuation trial for these patients were recorded at 6months and at last follow up. The first EEG was retrospectively, blindly, and visually assessed for focal slowing, focal discharges and also quantitatively analyzed for amplitude or latency asymmetries of generalized discharges. Association between these variables and development of drug-resistance was evaluated.

Results: Out of 51 subjects, 40% had some type of EEG asymmetry by visual, 37% by quantitative and 54% by combined analysis. Drug-resistance was identified in 52% of patients after 6months and in 24% at the end of the follow up period (∼4.2years). 27% of patients underwent a discontinuation trial; 43% unsuccessfully. There was no association between baseline EEG asymmetries of any type and refractoriness to medical therapy, regardless of analytical method used.

Conclusions: In a carefully selected cohort of medication-naïve GGE patients, visual and quantitative asymmetries in the first EEG were not associated with the development of pharmaco-resistance.

Significance: These findings do not provide support for utilization of EEG asymmetries as a prognostic tool in GGE.

Keywords: Drug resistance; EEG; GGE; IGE; Spike-wave asymmetries.

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Conflict of interest statement

None of the authors has any conflict of interest to disclose related to this study.

Figures

Fig. 1
Fig. 1
Example of epileptiform discharge distributions from refractory and controlled GGE patients. Panels A and B show EEG data demonstrating lateralized (A) and symmetric (B) generalized epileptiform discharges in two separate patients. Panels C and D show the overall distribution of spikes as a colorized topographical plot. Panel C demonstrates a strong lateralization of discharges (same patient as panel A), from a patient whose epilepsy was controlled at all time points. Panel D demonstrates symmetric discharges (same patient as panel B), from a patient with refractory epilepsy at all time points. Total number of quantitated discharges are as indicated.
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