Primary Generalized Seizure Disorder: Correlation of Epileptiform Discharges with Seizure Frequency

Miller, Harry W.; Blume, Warren T.

doi:10.1111/j.1528-1157.1993.tb02384.x

Cited by 9 publications

(3 citation statements)

References 17 publications

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“…This is expensive but necessary. Although EEG discharges are not a perfect surrogate for clinical seizures (41), the EEG is vital to supplement video observation (42). Video observation cannot be omitted, though, especially for myoclonus.…”

Section: Discussionmentioning

confidence: 99%

Clinical Trials for Treatment of Primary Generalized Epilepsies

Faught

2003

Epilepsia

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Summary:Purpose: To review the current state of knowledge of the treatment of primary (idiopathic) generalized epilepsy syndromes based on the efficacy results of clinical trials, to highlight obstacles in the design of these trials, and to suggest solutions for future research.Methods: Published reports of controlled clinical trials, as well as large or significant uncontrolled trials of treatments for these syndromes, were reviewed. Trials were selected for discussion based on their importance or their illustration of design issues.Results: Only a few randomized, controlled trials of therapy for these syndromes exist. Conclusions based on this Class I data include efficacy in absence epilepsies for ethosuximide, valproate, and lamotrigine, and for eight drugs for primary generalized tonic-clonic seizures. Many commonly accepted therapeutic strategies are not based on formal data. No controlled data exist for uncommon syndromes.Conclusions: More clinical trials of therapies for primary generalized epilepsies are needed. To overcome design obstacles, better funding, multicenter cooperation, inclusion of children, study designs requiring fewer patients, equivalent-control designs, use of EEG and video seizure counting, and better syndrome identification will be required. Key Words: Clinical trials-Generalized seizures-Primary generalized epilepsiesIdiopathic epilepsies-Antiepilepsy drugs.The design and interpretation of clinical trials for primary (idiopathic, genetic) generalized epilepsies involves consideration of several problems that differ from those encountered in clinical trials for localization-related epilepsies. Research in this area encounters some unique difficulties; consequently, data from well-controlled trials of therapies for these syndromes are sparse. There are fewer trials enrolling fewer patients, and very few data from Class I studies (randomized, controlled, blinded clinical trials) are available. We will review the problems associated with this endeavor, examine selected clinical trials for illustrative purposes, assign a quality level to therapeutic conclusions in the literature, then suggest possible solutions that may lead to better data and more confident therapeutic plans. This discussion is not a comprehensive review to support evidence-based guidelines. It includes only selected studies to illustrate problems and solutions, but includes most of those containing Class I evidence for efficacy. Choice of drug based on adverse effect profiles, ease of use, cost, and other variables is important, but this review focuses only on efficacy data.

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Section: Discussionmentioning

confidence: 99%

Clinical Trials for Treatment of Primary Generalized Epilepsies

Faught

2003

Epilepsia

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“…In a 15‐year follow‐up study of childhood absence (40), 65% were in remission. Another study found a high correlation between spike‐wave quantity on awake “resting” EEG and number of reported absence seizures (41). These children and adolescents generally have normal intellect although a minority have learning and behavioral difficulties (42).…”

Section: Correlation With Syndromesmentioning

confidence: 99%

The Progression of Epilepsy

Blume

2006

Epilepsia

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Summary: Prognosis for seizure control and cognitive development varies considerably among syndromes. Several factors may interact to influence outcome of an epilepsy including a causative etiology, ictal and interictal discharges, seizure‐related trauma or systemic perturbations, and antiepileptic drug (AED) effects. Clinical evidence convincingly supporting Gowers' hypothesis that seizures beget seizures is lacking. Short‐term seizure suppression by early treatment does not appear to influence long‐term prognosis. Malignant epilepsy syndromes usually begin in infancy or childhood, have a high seizure frequency, resist the initial AED, and are often associated with progressive cognitive dysfunction. Prompt management of some severe epilepsy syndromes may lessen cognitive decline. However, aggressive AEDs therapy must be balanced against the potential for cognitive side effects, particularly if multiple AEDs are used. Several experimental paradigms closely parallel human TLE as both have an initial precipitating injury (IPI), a latent period, then recurrent spontaneous seizures. In humans, an IPI is any medical event with neurological implications. Although transition from a latent period to a seizure disorder certainly constitutes “progression” of the disorder, convincing clinical evidence of subsequent worsening has not emerged. Substantial clinical and experimental evidence indicates some cognitive regression and focal atrophy with time for TLE and other intractable syndromes. However, seizure frequency and severity, established early in the disorder, appear stable in most patients, and even regress in benign syndromes. Factors mitigating or extinguishing epilepsies need to be further sought.

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“…As the quantity of interictal spike-waves correlates highly with the number of clinical absence attacks, the EEG may be used to assess effectiveness of therapy. 33 The incidence of generalised tonic-clonic seizures (GTC) is slightly greater among: 1) adolescents, 2) those with 3-6 Hz spike wave discharges, and 3) those with only the shorter bursts. Some younger patients with 3 Hz spike waves have principally myoclonic seizures.…”

Section: Clinical Correlatesmentioning

confidence: 99%

Invited Review: Clinical and Basic Neurophysiology of Generalised Epilepsies

Blume

2002

Can. j. neurol. sci.

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Electroencephalography (EEG) clarifies several aspects of generalised epileptic seizures and epilepsies. For the clinician, it assists in the diagnosis of the epileptic condition and helps assign the disorder to an appropriate syndrome. This assignation and the quantity of epileptic discharges estimate severity and prognosis. When combined with relevant basic science investigations, EEG studies may disclose significant pathophysiological mechanisms. Therefore, this paper first describes EEG characteristics of the several disorders included under the broad category of “generalised”. The review then relates these phenomena to germane experimental data intending that this binocular survey will provide a more meaningful perspective of these disorders.

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Primary Generalized Seizure Disorder: Correlation of Epileptiform Discharges with Seizure Frequency

Cited by 9 publications

References 17 publications

Clinical Trials for Treatment of Primary Generalized Epilepsies

Clinical Trials for Treatment of Primary Generalized Epilepsies

The Progression of Epilepsy

Invited Review: Clinical and Basic Neurophysiology of Generalised Epilepsies

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