Pretreatment EEG in childhood absence epilepsy

Dlugos, Dennis J.; Shinnar, Shlomo; Cnaan, Avital; Hu, Fengming; Moshé, Solomon L.; Mizrahi, Eli M.; Masur, David; Sogawa, Yoshi; Pichon, Jean Baptiste Le; Levine, C.M.; Hirtz, Deborah; Clark, Peggy; Adamson, Peter C.; Glauser, Tracy A.

doi:10.1212/wnl.0b013e31829a3373

Cited by 67 publications

(55 citation statements)

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“…Sex, race, and ethnicity had no association with the risk of a GTC (table 1) or Table 1 Baseline demographic, pretreatment characteristics, initial therapy, and response of patients who did and did not develop a GTC 1 and 2). In contrast, duration of shortest burst on EEG, which was associated with a differential rate of freedom from failure at week 16-20 visit, 10 was also associated with a modest association with the risk of developing a GTC (hazard ratio [HR] 0.939, 95% CI 0.886-0.996, see table 2), with shorter duration being associated with a higher risk of developing GTCs.…”

Section: Resultsmentioning

confidence: 99%

“…The EEG parameter is also associated with a differential rate of treatment response at the week 16-20 visit and of attentional problems. 10 Interestingly, the participants with a shorter duration of shortest EEG burst have a lower treatment success rate and a higher risk of developing GTCs, but a lower rate of attentional problems. This suggests, as we have previously postulated, 9,10 that specific features of the EEG may serve to identify subtypes of CAE.…”

Section: Resultsmentioning

confidence: 99%

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Long-term outcomes of generalized tonic-clonic seizures in a childhood absence epilepsy trial

Shinnar

Cnaan²,

Hu³

et al. 2015

Neurology

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Objective: To determine incidence and early predictors of generalized tonic-clonic seizures (GTCs) in children with childhood absence epilepsy (CAE).Methods: Occurrence of GTCs was determined in 446 children with CAE who participated in a randomized clinical trial comparing ethosuximide, lamotrigine, and valproate as initial therapy for CAE.Results: As of June 2014, the cohort had been followed for a median of 7.0 years since enrollment and 12% (53) have experienced at least one GTC. The median time to develop GTCs from initial therapy was 4.7 years. The median age at first GTC was 13.1 years. Fifteen (28%) were not on medications at the time of their first GTC. On univariate analysis, older age at enrollment was associated with a higher risk of GTCs (p 5 20.0009), as was the duration of the shortest burst on the baseline EEG (p 5 0.037). Failure to respond to initial treatment (p , 0.001) but not treatment assignment was associated with a higher rate of GTCs. Among patients initially assigned to ethosuximide, 94% (15/16) with GTCs experienced initial therapy failure (p , 0.0001). A similar but more modest effect was noted in those initially treated with valproate (p 5 0.017) and not seen in those initially treated with lamotrigine. Conclusions:The occurrence of GTCs in a well-characterized cohort of children with CAE appears lower than previously reported. GTCs tend to occur late in the course of the disorder. Children initially treated with ethosuximide who are responders have a particularly low risk of developing subsequent GTCs. Neurology ® 2015;85:1108-1114 GLOSSARY AED 5 antiepileptic drug; CAE 5 childhood absence epilepsy; CI 5 confidence interval; GTC 5 generalized tonic-clonic seizure; HR 5 hazard ratio; IQR 5 interquartile range; JAE 5 juvenile absence epilepsy; RCT 5 randomized controlled trial.Childhood absence epilepsy (CAE) is the most common childhood-onset epilepsy syndrome, accounting for 10%-17% of all childhood-onset epilepsy.1,2 Although the core seizure type in CAE is absence seizures, studies have reported that generalized tonic-clonic seizures (GTCs) occur in 30%-60% of children with CAE.3,4 Lack of clarity about the homogeneity of these reports' study populations means the incidence of GTCs remains unclear. The timing of GTC onset in children with CAE is also imprecise but GTCs tend to occur late in the course of CAE with latencies of 5-10 years after syndrome onset. 3,4 A double-blind randomized controlled trial (RCT) of initial therapy for children with CAE enrolled 446 children with newly diagnosed CAE (without a history of GTCs) and randomized them to ethosuximide, lamotrigine, or valproate. 5,6 This cohort was well-characterized with pretreatment and subsequent prospective longitudinal assessment of seizure status, EEG, cognition, and behavioral status. The RCT identified ethosuximide as the optimal initial therapy due to superior efficacy compared with lamotrigine and similar efficacy but fewer attentional side effects when compared to valproic acid. 5,6 The results of th...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Long-term outcomes of generalized tonic-clonic seizures in a childhood absence epilepsy trial

Shinnar

Cnaan²,

Hu³

et al. 2015

Neurology

View full text Add to dashboard Cite

show abstract

“…An underlying structural or functional abnormality of the brain has been postulated to explain both observations. 3,4 This article by Dlugos et al 5 is a post hoc analysis of a randomized, double-blinded trial 6 that seeks to characterize the relationship between EEG characteristics prior to treatment, measures of attention, and the outcome of initial antiepileptic treatment.…”

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confidence: 99%

“…Demographic information is presented in table 1. 5 Inclusion criteria required an EEG demonstrating GSW with frequency between 2.7 and 5 Hz, a normal background, and at least 1 GSW with duration greater than or equal to 3 seconds. EEGs were obtained by local providers and reviewed by local investigators as well as a central EEG reader.…”

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confidence: 99%