Epilepsy with Developmental Delay and Intellectual Disabilities - Clinical, Radiographic, Electroencephalographic Features in Adults with Epilepsy
Abstract number :
2.085
Submission category :
4. Clinical Epilepsy / 4B. Clinical Diagnosis
Year :
2021
Submission ID :
1826063
Source :
www.aesnet.org
Presentation date :
12/5/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:51 AM
Authors :
Hira Pervez, MD - University of Toledo COM; Sihyeong Park, MD - PGY3 Neurology Resident, Neurology, University of Toledo COM; Sidra Saleem, MD - PGY2 Neurology Resident, Neurology, University of Toledo COM; Ajaz Sheikh, MD - Assistant Professor, Neurology, University of Toledo COM; Michael Nagel, MD - Assistant Professor, Neurology, University of Toledo COM; Naeem Mahfooz, MD - Assistant Professor, Neurology, University of Toledo COM; Imran Ali, MD - Professor and Chair, Neurology, University of Toledo COM LS; Anum Riaz, MD - Assistant Professor, Neurology, University of Toledo COM LS
Rationale: This study aims to evaluate and analyze the clinical, EEG, and radiologic features associated with Developmental delay/Intellectual disabilities (DD/ID) in adult patients with epilepsy.
Methods: This retrospective chart review identified patients with DD/ID evaluated from 2017-21. The database was stratified based on seizure-onset, epilepsy type, MRI, EEG findings, comorbidities and anti-seizure medications used both as mono and polytherapy.
Results: DD/ID was found in 258/3200 (8.0%) patients. This dataset included 145 (56.2%) men and 113 (43.7%) women with a mean age of 39.97 +/- 13.79. Autistic features were noted in 45/258 (17.4%).
Majority 191 (86%) presented with focal onset seizures, 31 (12%) with generalized, and 36 (13.95%) with an unknown seizure onset. Majority 183/191 (95.81%) had a focal motor onset and 15 (7.85%) focal non-motor onset whereas 157/191 (82.19%) had secondary generalization.
Most patients 185 (71.7%) were diagnosed with focal epilepsy, 30 (11.62%) with generalized, 16 (6.2%) with combined, and 27 (10.4%) could not be classified. An abnormal MRI was seen in 82/133 (61.65%) with cortical dysplasia (CD) 12/82(14.63%) and callosal atrophy/thinning 10/82 (12.19%) were the most commonly identified abnormalities.
Abnormal routine EEGs were noted in 169/201 (84%) with epileptiform activity in 91/169 (53.84%), including both focal 68/91 (74.92%) and generalized 23/91 (25.27%) epileptiform discharges. A total of 81/92(88%) patients who underwent video-EEG monitoring were abnormal, with 60/81 (74%) displaying epileptiform activity, mostly focal 45/60 (75%) and generalized in 15/60 (25%).
Levetiracetam (LVT) was the most commonly used ASD both as mono therapy 15/61 (24.5%) and poly-therapy 40/182(21.9%). About 99/258 (38.37%) patients developed intractable epilepsy. VNS therapy was utilized in 50/258 (19.37%) and 7/258(2.71%) underwent epilepsy surgery. Complete seizure resolution was seen in 50 (19.37%), with 6-month seizure-free state noted in 118/258 (45.73%), and 11/50 (22%) in the VNS arm.
Conclusions: DD/ID is a common co-morbidity in adults with epilepsy. Most often the seizures were focal in onset (86%) with secondary generalization (82%) in our study. Cortical dysplasia was a commonly observed structural abnormality. LVT was the most frequently used ASD, both as mono and polytherapy. Approximately 45% of all patients with ID/DD were seizure-free.
Funding: Please list any funding that was received in support of this abstract.: NA.
Clinical Epilepsy