Evaluation of Seizure Frequency Distribution in Epileptic Patients with Normal and Abnormal Electroencephalogram in Al-Zahra Hospital of Isfahan

Najafi, Mohmmad Reza; Meamar, Rokhsareh; Karimi, Nafiseh

Evaluation of Seizure Frequency Distribution in Epileptic Patients with Normal and Abnormal Electroencephalogram in Al-Zahra Hospital of Isfahan

Document Type : Original Article

Authors

¹ Department of Neurology, Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Al-Zahra Hospital, Isfahan, Iran

² Isfahan Endocrine and Metabolic Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

³ Medical Student Research Center, Isfahan University of Medical Sciences, Medical School, Isfahan, Iran

Abstract

Background: Epilepsy is a chronic neurological disorder characterized by seizure recurrence in patients. Electroencephalogram (EEG) has a diagnostic and prognostic role in the management of patients. Studies have shown a significant relation between seizure recurrence and abnormal EEG in newly diagnosed epileptic patients, and people with first episode of unprovoked seizure. The aim of this study is to evaluate seizure frequency in chronic epileptic patients on drug therapy based on normal or abnormal EEG. Materials and Methods: This prospective cohort study examined seizure recurrence in 59 epileptic patients (50.8% generalized, 49.2% focal) with normal and abnormal EEG. Data were recorded in patient medical file, and patients were followed by telephone call or visiting by neurologist. Results: In this study, 59 patients with a mean age of 29.58 ± 10.37 years were assessed that 42.4% of them were males and 57.6% were females. Seizure frequency in patient with specific abnormal EEG was significantly more than other patients (specific abnormal: 78.9%, nonspecific abnormal: 45.5%, and normal: 31%, P = 0.005). Seizure recurrence in patients on polytherapy was significantly higher than others (polytherapy: 76.9% and monotherapy: 27.3%, P < 0.001). In patient with abnormal imaging seizure, frequency was more than other patients which was nearly significant (P = 0.054). Conclusion: Abnormal EEG and number of anticonvulsant drugs have a role in seizure recurrence in epileptic patients.

Keywords

References

1.	Iliescu C, Craiu D. Diagnostic approach of epilepsy in childhood and adolescence. Maedica (Buchar) 2013;8:195-9. [PUBMED]
2.	Fisher RS, Acevedo C, Arzimanoglou A, Bogacz A, Cross JH, Elger CE, et al. ILAE official report: A practical clinical definition of epilepsy. Epilepsia 2014;55:475-82.
3.	Fisher RS, van Emde Boas W, Blume W, Elger C, Genton P, Lee P, et al. Epileptic seizures and epilepsy: Definitions proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE). Epilepsia 2005;46:470-2.
4.	Berg AT, Berkovic SF, Brodie MJ, Buchhalter J, Cross JH, van Emde Boas W, et al. Revised terminology and concepts for organization of seizures and epilepsies: Report of the ILAE commission on classification and terminology, 2005-2009. Epilepsia 2010;51:676-85.
5.	Berg AT, Shinnar S, Levy SR, Testa FM. Newly diagnosed epilepsy in children: Presentation at diagnosis. Epilepsia 1999;40:445-52.
6.	Serrano-Castro PJ, Mauri-Llerda JA, Hernández-Ramos FJ, Sánchez-Alvarez JC, Parejo-Carbonell B, Quiroga-Subirana P, et al. Adult prevalence of epilepsy in Spain: Epiberia, a population-based study. Scientific World J 2015;2015:602710.
7.	Sayehmiri K, Tavan H, Sayehmiri F, Mohammadi I, Carson KV. Prevalence of epilepsy in Iran: A meta-analysis and systematic review. Iran J Child Neurol 2014;8:9-17.
8.	El-Tallawy HN, Farghaly WM, Rageh TA, Shehata GA, Metwally NA, Badry R, et al. Spectrum of epilepsy – Prevalence, impact, and treatment gap: An epidemiological study from Al-Quseir, Egypt. Neuropsychiatr Dis Treat 2016;12:1111-8.
9.	Smith SJ. EEG in the diagnosis, classification, and management of patients with epilepsy. J Neurol Neurosurg Psychiatry 2005;76 Suppl 2:ii2-7.
10.	Pillai J, Sperling MR. Interictal EEG and the diagnosis of epilepsy. Epilepsia 2006;47 Suppl 1:14-22.
11.	Hughes JR, Gruener G. The success of EEG in confirming epilepsy-revisited. Clin EEG Neurosci 1985;16:98-103.
12.	Hauser WA, Rich SS, Annegers JF, Anderson VE. Seizure recurrence after a 1^st unprovoked seizure: An extended follow-up. Neurology 1990;40:1163-70.
13.	Scotoni AE, Guerreiro MM, De Abreu HJ. First epileptic crisis. Analysis of risk factors for recurrence. Arq Neuropsiquiatr 1999;57:392-400.
14.	Betting LE, Mory SB, Lopes-Cendes I, Li LM, Guerreiro MM, Guerreiro CA, et al. EEG features in idiopathic generalized epilepsy: Clues to diagnosis. Epilepsia 2006;47:523-8.
15.	Betting LE, Mory SB, Lopes-Cendes I, Li LM, Guerreiro MM, Guerreiro CA, et al. MRI reveals structural abnormalities in patients with idiopathic generalized epilepsy. Neurology 2006;67:848-52.
16.	Schreiner A, Pohlmann-Eden B. Value of the early electroencephalogram after a first unprovoked seizure. Clinical EEG Neurosci 2003;34:140-4.
17.	Yang LH, Jiang LY, Lu RY, Zhong JQ, Liu SQ, Tao EX, et al. Correlation between the changes in ambulatory electroencephalography findings and epilepsy recurrence after medication withdrawal among the population in Southern China. Neurol Med Chir 2013;53:12-6.
18.	Lamdhade SJ, Taori GM. Study of factors responsible for recurrence of seizures in controlled epileptics for more than 1½ years after withdrawal of antiepileptic drugs. Neurol India 2002;50:295-300. [PUBMED] [Full text]
19.	Hawash KY, Rosman NP. Do partial seizures predict an increased risk of seizure recurrence after antiepilepsy drugs are withdrawn? J Child Neurol 2003;18:331-7.
20.	Winckler MI, Rotta NT. Clinical and electroencephalographic follow-up after a first unprovoked seizure. Pediatr Neurol 2004;30:201-6.
21.	Kim LG, Johnson TL, Marson AG, Chadwick DW; MRC MESS Study Group. Prediction of risk of seizure recurrence after a single seizure and early epilepsy: Further results from the MESS trial. Lancet Neurol 2006;5:317-22.
22.	Russ SA, Larson K, Halfon N. A national profile of childhood epilepsy and seizure disorder. Pediatrics 2012;129:256-64.
23.	Arthur TM, deGrauw TJ, Johnson CS, Perkins SM, Kalnin A, Austin JK, et al. Seizure recurrence risk following a first seizure in neurologically normal children. Epilepsia 2008;49:1950-4.
24.	Giza CC, Kutcher JS, Ashwal S, Barth J, Getchius TS, Gioia GA, et al. Summary of evidence-based guideline update: Evaluation and management of concussion in sports: Report of the guideline development subcommittee of the American Academy of Neurology. Neurology 2013;80:2250-7.
25.	Khan RB, Onar A. Seizure recurrence and risk factors after antiepilepsy drug withdrawal in children with brain tumors. Epilepsia 2006;47:375-9.
26.	Kalita J, Vajpeyee A, Misra UK. Predictors of one-year seizure remission – A clinicoradiological and electroencephalographic study. Electromyogr Clin Neurophysiol 2005;45:161-6.
27.	Verrotti A, Latini G, Giannuzzi R, Cutarella R, Trotta D, Morgese G, et al. Factors associated with poor control in partial complex epilepsy. J Child Neurol 2004;19:262-4.
28.	Berg AT. Risk of recurrence after a first unprovoked seizure. Epilepsia 2008;49 Suppl 1:13-8.
29.	Verrotti A, Trotta D, Salladini C, Morgese G, Chiarelli F. Risk factors for recurrence of epilepsy and withdrawal of antiepileptic therapy: A practical approach. Ann Med 2003;35:207-15.
30.	Deckers CL, Hekster YA, Keyser A, van Lier HJ, Meinardi H, Renier WO. Monotherapy versus polytherapy for epilepsy: A multicenter double-blind randomized study. Epilepsia 2001;42:1387-94.

Advanced Biomedical Research