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Objective: To assess prognostic patterns and investigate clinical and electroencephalography (EEG) variables associated with persistent treatment resistance in a population of genetic generalized epilepsy (GGE) patients with a long-term follow-up.

Methods: Data from GGE patients followed from 1975 to 2019 were reviewed retrospectively. Subjects with a follow-up >10 years, starting from epilepsy diagnosis, were included. Persistent treatment resistance was defined as the absence of any period of remission ≥1 year despite treatment with two appropriate and adequate antiepileptic drugs (AEDs).

Results: One hundred ninety-nine patients were included. The median age was 39.5 years (interquartile range [IQR] 30-49) and the median follow-up was 27 years (IQR 18-35). The most common syndrome was juvenile myoclonic epilepsy (JME), diagnosed in 44.2% of patients. During follow-up, 163 subjects (81.9%) experienced 3-year remission from any seizure type, whereas 5- and 10-year remission occurred in 141 (70.8%) and 92 (46.2%) cases, respectively. The most common prognostic pattern was a relapsing-remitting course, observed in 80 patients (40.2%), whereas 29 (14.6%) displayed persistent treatment resistance. According to multivariable logistic regression analysis, febrile seizures (FS), specific EEG patterns (namely generalized paroxysmal fast activity, GPFA) and valproate (VPA) resistance were the only variables significantly associated with persistent treatment resistance. JME was the only epilepsy syndrome statistically associated with persistent treatment resistance in univariable logistic regression analysis.

Significance: Persistent treatment resistance was observed in almost 15% of GGE patients followed in a tertiary epilepsy center. A worse outcome was associated with specific clinical variables (JME, FS) and EEG patterns (GPFA).

Titel:	Persistent treatment resistance in genetic generalized epilepsy: A long-term outcome study in a tertiary epilepsy center.
Autor/in / Beteiligte Person:	Cerulli Irelli, E ; Morano, A ; Barone, FA ; Fisco, G ; Fanella, M ; Orlando, B ; Fattouch, J ; Manfredi, M ; Giallonardo, AT ; Di Bonaventura, C
Link:	Zum Volltext
Zeitschrift:	Epilepsia, Jg. 61 (2020-11-01), Heft 11, S. 2452-2460
Veröffentlichung:	Malden, MA : Blackwell Science ; <i>Original Publication</i>: Copenhagen : Munskgaard, 2020
Medientyp:	academicJournal
ISSN:	1528-1167 (electronic)
DOI:	10.1111/epi.16708
Schlagwort:	Adult Anticonvulsants pharmacology Cohort Studies Drug Resistant Epilepsy drug therapy Drug Resistant Epilepsy genetics Drug Resistant Epilepsy physiopathology Electroencephalography trends Epilepsy, Generalized physiopathology Female Humans Longitudinal Studies Male Middle Aged Myoclonic Epilepsy, Juvenile drug therapy Myoclonic Epilepsy, Juvenile genetics Myoclonic Epilepsy, Juvenile physiopathology Retrospective Studies Time Factors Treatment Outcome Valproic Acid pharmacology Anticonvulsants therapeutic use Electroencephalography drug effects Epilepsy, Generalized drug therapy Epilepsy, Generalized genetics Valproic Acid therapeutic use
Sonstiges:	Nachgewiesen in: MEDLINE Sprachen: English Publication Type: Journal Article; Observational Study Language: English [Epilepsia] 2020 Nov; Vol. 61 (11), pp. 2452-2460. <i>Date of Electronic Publication: </i>2020 Oct 14. MeSH Terms: Anticonvulsants / therapeutic use ; Electroencephalography / drug effects ; Epilepsy, Generalized / drug therapy ; Epilepsy, Generalized / genetics ; Valproic Acid / *therapeutic use ; Adult ; Anticonvulsants / pharmacology ; Cohort Studies ; Drug Resistant Epilepsy / drug therapy ; Drug Resistant Epilepsy / genetics ; Drug Resistant Epilepsy / physiopathology ; Electroencephalography / trends ; Epilepsy, Generalized / physiopathology ; Female ; Humans ; Longitudinal Studies ; Male ; Middle Aged ; Myoclonic Epilepsy, Juvenile / drug therapy ; Myoclonic Epilepsy, Juvenile / genetics ; Myoclonic Epilepsy, Juvenile / physiopathology ; Retrospective Studies ; Time Factors ; Treatment Outcome ; Valproic Acid / pharmacology References: Mullen SA, Berkovic SF. Genetic generalized epilepsies. Epilepsia. 2018;59:1148–53. ; Jallon P, Latour P. Epidemiology of idiopathic generalized epilepsies. 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Persistent treatment resistance in genetic generalized epilepsy: A long-term outcome study in a tertiary epilepsy center.