Generalized Tonic-Clonic Seizures in Patients with Focal Epilepsy during Video-EEG Monitoring
Abstract number :
3.166
Submission category :
Clinical Epilepsy-Adult
Year :
2006
Submission ID :
6829
Source :
www.aesnet.org
Presentation date :
12/1/2006 12:00:00 AM
Published date :
Nov 30, 2006, 06:00 AM
Authors :
1Mordekhay Medvedovsky, 1,2Svetlana Kipervasser, 3Batya B. Davidovici, 4Tatiana Vander, and 1,2Miri Y. Neufeld
Video-EEG monitoring (VEM) is a vital diagnostic tool in the pre-operative work-up of patients suffering from intractable focal epilepsy. During VEM, anti-epileptic drug (AED) dosages are often reduced in order to induce focal seizures in patients; an unavoidable side effect can sometimes be generalized tonic-clonic seizures (GTCS). The goal of this study was to answer two questions:
1) What are the risk factors for GTCS in patients with focal epilepsy during VEM?
2) At what stage in the reduction of AEDs will GTCS most likely occur?, We retrospectively reviewed the records of all adult patients ([gt]18y) hospitalized in the VEM Unit in the Tel-Aviv Sourasky Medical Center from 2002-2005, with focal epilepsy who also had GTCS. A comparative group was created by reviewing the records of the first patient of each month who had focal epilepsy but who did not have a GTCS during VEM hospitalization. The drug reduction in both groups was done using identical protocol., Fifty-one patients with GTCS were identified and compared with 48 patients in the control group. Men were more prevalent in the group with GTCS [ndash] 34 (61%) [ndash] than in the control group [ndash] 22 (39%) (p=0.037). More patients with GTCS during VEM also had a history of GTCS [ndash] 45 (58%)/33 (42%) (p=0.018); a history of simple partial seizures (SPS) was less prevalent in the group with GTCS [ndash] 33 (45%)/40 (54.8%) p=0.035).
There was a clustering of GTCS on the seventh day from the start of AED reduction (8 patients). Women had GTCS earlier (5.75 days, SD 3.53) than men (8.15 days, SD 6.083) (p=0.033). Patients with a history of febrile convulsions had GTCS later (9.35 days, SD 7.71) compared with patients with no history of febrile convulsions (6.79 days, SD 4.59) (p=0.027)., The risk factors for GTCS in patients with focal epilepsy during VEM were shown to be: male gender, history of GTCS and absence of history of SPS; women and patients with no history of febrile convulsions have GTCS earlier, and the risk of GTCS is highest on the seventh day from the onset of AED reduction. These results provide a helpful tool in predicting risk factors for GTCS during drug dosage reduction in VEM.,
Clinical Epilepsy