Factors associated with tonic-clonic seizures in patients with drug-resistant mesial temporal epilepsy.
OBJECTIVE
Among different seizure types, tonic-clonic seizures are more significant because they are more often associated with morbidity. No prior study has been done to investigate risk factors associated with tonic-clonic seizures in patients with mesial temporal epilepsy.


METHODS
In this retrospective study, all drug-resistant mesial temporal epilepsy patients in the database of patients who underwent epilepsy surgery at Jefferson comprehensive epilepsy center were recruited. These patients were prospectively registered in a database from 1986 till 2014. Patients' age, gender, epilepsy risk factors, age at seizure onset, and preoperative seizure type(s) were registered routinely. Potential risk factors associated with experiencing preoperative tonic-clonic seizures were investigated.


RESULTS
Two hundred seventy-five patients (132 males and 143 females) were studied. Aura type was associated with experiencing perioperative tonic-clonic seizures. Patients with epigastric auras less frequently reported having tonic-clonic seizures compared with those who had other types of auras (odds ratio: 0.37 and 95% confidence interval: 0.19-0.70; p=0.001) and those who did not have any auras (odds ratio: 0.35 and 95% confidence interval: 0.16-0.77; p=0.008).


CONCLUSIONS
Epigastric auras may indicate that a specific anatomic location is involved in epileptogenesis from which generalization is harder because of that location's poor connections with other brain regions.
Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA. Electronic address: aliasadipooya@yahoo.com.
Ali A
AA
Asadi-Pooya
Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA. Electronic address: crostami11@gmail.com.
Cyrus
C
Rostami
Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA. Electronic address: amin.rabiei@jefferson.edu.
Amin H
AH
Rabiei
Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA. Electronic address: michael.sperling@jefferson.edu.
Michael R
MR
Sperling
D000328:Adult; D000069279:Drug Resistant Epilepsy; D004569:Electroencephalography; D004833:Epilepsy, Temporal Lobe / Q000150:complications*; D004830:Epilepsy, Tonic-Clonic / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
Associated factors; Temporal lobe epilepsy; Tonic–clonic seizure