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Epileptiform Asymetries and Treatment Response in Juvenile Myoclonic Epilepsy

Published online by Cambridge University Press:  23 September 2016

Karine Létourneau ,
Cécile Cieuta-Walti  and
Charles Deacon
Karine Létourneau
Affiliation:
Department of Neurology, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
Cécile Cieuta-Walti
Affiliation:
Department of Neuropediatry, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
Charles Deacon*
Affiliation:
Department of Neurology, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
*
Département de Neurologie, Centre Hospitalier Universitaire de Sherbrooke, 3001, 12ième avenue Nord, Sherbrooke, Québec, J1H 5N4, Canada
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Abstract

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Background:

Epileptiform electroencephalogram (EEG) asymmetries are not uncommon in juvenile myoclonic epilepsy (JME) and can contribute to the misdiagnosis of this syndrome. The objective of this study is to further characterize patients with focal or asymmetric epileptiform electroencephalographic abnormalities and more specifically in terms of response to treatment. Controversial data exists in the literature concerning this issue.

Methods:

We retrospectively reviewed clinical and EEG data of a group of consecutive JME patients followed at our Epilepsy Service. The first EEG available for each patient was reviewed blindly by two independent electroencephalographers.

Results:

Twenty-eight patients with JME were identified: 11 (39.3%) were resistant to at least one appropriate anti-epileptic drug (AED), including valproate, lamotrigine, topiramate or levetiracetam. All patients except two had generalized epileptiform abnormalities. Overall, EEG asymmetries were detected in 57.1% of the cases. The proportion of EEG asymmetries between AED-sensitive group (52.9%) and AED-resistant group (63.5%) did not reach statistical significance. Concordance between examiners for identification of EEG asymmetries was good. Analysis of patients with and without asymmetries showed no statistically significant differences in comparisons of age, family history of seizure, presence of polyspike and slow wave, photosensitivity and timing of EEG related to the onset of treatment.

Conclusion:

Asymmetric electroencephalographic abnormalities are frequent in patients with JME. These features should not be misinterpreted as being indicative of partial epilepsy. In our group, asymmetries were not associated with resistance to treatment.

Résumé

RésuméContexte:

Les asymétries épileptiformes à l'EEG sont fréquentes dans l'épilepsie myoclonique juvénile (EMJ) et peuvent contribuer à un diagnostic erroné de ce syndrome. Le but de cette étude était de mieux caractériser les patients qui ont des anomalies focales ou des anomalies asymétriques épileptiformes à l'EEG, plus particulièrement en ce qui concerne la réponse au traitement. Il existe dans la littérature des données controversées à ce sujet.

Méthodologie:

Nous avons révisé rétrospectivement les données cliniques et électroencéphalographiques d'un groupe de patients consécutifs atteints d'EMJ, suivi à notre service d'épilepsie. Le premier EEG disponible pour chaque patient a été révisé à l'aveugle par deux électroencéphalographistes indépendants.

Résultats:

Vingt-huit patients atteints d'EMJ ont été identifiés, dont 11 (39,3%) étaient résistants à au moins un médicament antiépileptique approprié (AEA), incluant le valproate, la lamotrigine, le topiramate ou le lévétiracétam. Tous les patients sauf deux avaient des anomalies épileptiformes généralisées. Dans l'ensemble, des asymétries EEG ont été détectées chez 57,1% des patients. La proportion des asymétries à l'EEG entre le groupe sensible aux AEA (52,9%) et le groupe résistant aux AEA (63,5%) n'atteignait pas le seuil de la significativité à l'analyse statistique. La concordance pour l'identification des asymétries à l'EEG entre les observateurs était bonne. L'analyse des patients avec et sans asymétries n'a pas montré de différence significative quant à l'âge, l'histoire familiale de crises convulsives, la présence de poly-pointes-ondes et d'ondes lentes, de photosensibilité et au moment où le traitement a été commencé.

Conclusion:

Les anomalies électroencéphalographiques asymétriques sont fréquentes chez les patients atteints d'EMJ. Ces particularités ne devraient pas être interprétées comme indicatrices d'une épilepsie partielle. Dans notre groupe de patients, les asymétries n'étaient pas associées à la résistance au traitement

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 37 , Issue 6 , November 2010 , pp. 826 - 830
Copyright
Copyright © The Canadian Journal of Neurological 2010

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