Prognostic factors in patients with refractory idiopathic generalized epilepsy.
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.



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.



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.



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.
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.
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Gomez-Ibañez
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.
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McLachlan
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.
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Mirsattari
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.
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Diosy
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.
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Burneo
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use; D000069279:Drug Resistant Epilepsy / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D004569:Electroencephalography; D004829:Epilepsy, Generalized / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012189:Retrospective Studies; D013226:Status Epilepticus / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D016896:Treatment Outcome; D055815:Young Adult
D000927:Anticonvulsants
Drug-resistance; Generalized epilepsy; Lifestyle; Prognosis