Abstracts

Rationale: The prodromes are defined as signs or symptoms that precede a seizure onset by up to 24 hours and are perceived by the patient and/or observer as premonitory. The frequency of prodromes in epilepsy patients has been reported to range from 6% to 41%. Although prodromal signs may herald the onset of overlooked seizures, they are frequently misdiagnosed as aura or psychological symptoms. In this study, it was aimed to clinically and electrophysiologically investigate prodromes by video EEG monitoring in epilepsy patients with drug resistant epilepsy. Methods: Thirty-eight patients (22 females and 16 males), who were candidates for epilepsy surgery and were evaluated by video EEG monitoring between January-December 2015, were enrolled in this study. Patients were evaluated in terms of clinical and electrophysiological features and prodromes that occurred 24 hours before the onset of epileptic seizure. In addition, depression was documented by using Beck Depression Inventory. Results: Although 38 patients with a mean age of 31±18 years were evaluated initially, two patients with a definite diagnosis of psychogenic non-epileptic seizure were excluded from the study. The mean duration of epilepsy was 16.5±8.4 years. All patients were on polytherapy for epilepsy. Thirty-one of patients had focal epilepsy and the remaining patients had generalized epilepsy. The etiological factors were as follows: structural in 18 patients, genetic in 4 patients and unknown in 14 patients. Seventeen (47%) patients had prodromes. Female to male ratio was 12/5 in patients with prodromes. The prodromes were as follows: behavioral changes in 8 patients, mood changes and headache in 5 patients, sleep disturbances in 3 patients, cognitive changes in 2 patients and dysthermia and speech disturbance in 1 patient. Some patients described more than one prodrome. All patients with prodromes except one had focal epilepsy. Prodromes were spontaneously reported by nearly half of the patients (n=8) and the remaining patients stated their prodromes when questioned. The duration of prodromes ranged from 2 to 24 hours. Twenty to hundred percent of seizures in these patients were accompanied by prodromes. Electrophysiological assessment of prodromal phases revealed no ictal activity. While 12 patients with prodromes suffered from variable degrees of depression, only 4 patients without prodrome had relatively mild depression. Conclusions: It is worth mentioning that nearly half of the patients with drug-resistant epilepsy had prodromes and that almost fifty percent of these patients stated their prodromes when questioned. Regarding this, all patients with epilepsy should be questioned for prodromes. Consistent with other studies, behavioral changes were the most frequent symptom. Depression was statistically significantly higher in patients with prodromes (p=0.01). Considering their frequency and potential value to detect associated depression in patients, prodromes should be routinely evaluated in the medical history of patients in daily clinical practice. Funding: none