Clinical, radiological and electrophysiological predictors for drug-resistant epilepsy

Abstract

Background Epilepsy is the third chronic brain illness worldwide. About a third of the epileptic patients will be drug resistant. Early identification of these patients is critical for appropriate treatment selection and prevention of the devastating consequences of recurrent seizures. The objective of this study aims to detect clinical, electrophysiological, and radiological predictors for drug-resistant epilepsy patients. Results One hundred fifty-five patients were included in this study, divided into a well-controlled epilepsy group (103 patients) and a drug-resistant group (52 patients). Both groups were compared regarding clinical, electrophysiological, and neuro-radiological data. Younger age at onset, history of delayed milestones, history of perinatal insult (especially hypoxia), mental retardation, neurological deficits, depression, status epilepticus (SE), complex febrile seizures, focal seizure to bilateral tonic–clonic convulsion as well as multiple seizures and high seizure frequency (daily) at onset, poor response to first anti-seizure drug (ASD), structural and metabolic etiology, abnormal brain imaging, and slow background and multifocal epileptiform discharges in EEG were significant risk factors for the development of drug-resistant epilepsy. Conclusion MRI abnormalities are the most significant predictor for drug-resistant epilepsy. Drug-resistant epilepsy is associated with clinical, electrophysiological, and radiological risk factors that can be used to diagnose drug-resistant patients early and choose the best treatment option and time.

Drug-Resistant Epilepsy: Experience From a Tertiary Care Center in Saudi Arabia

“…Several studies have indicated that symptomatic etiologies strongly predict drug resistance in patients with epilepsy [ 23 , 24 ], with structural etiologies being the most frequently reported in patients with DRE [ 23 , 25 ]. Similarly, in our patients with a known etiology of epilepsy, structural etiologies were the most common.…”

“…EEG was available for review in approximately 80% of our patients; similar rates have been reported in the literature [ 20 ]. A study investigating electrophysiological predictors for DRE revealed that abnormal EEG findings were significantly more common in patients with DRE (69.2%) than in the well-controlled group (44.7%) [ 23 ]. In contrast, in our cohort, abnormal EEG findings were reported in only 27.5% of those who underwent EEG.…”