Electroclinical features and long-term therapeutic response in patients with typical absence seizures

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Electroclinical features and long-term therapeutic response in patients with typical absence seizures. / Vlachou, Maria; Skrimpas, Georgios Alexandros; Kural, Mustafa Aykut et al.

In: Epileptic Disorders, Vol. 24, No. 2, 01.04.2022, p. 315-322.

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Vlachou M, Skrimpas GA, Kural MA, Rackauskaite G, Nikanorova N, Christensen J et al. Electroclinical features and long-term therapeutic response in patients with typical absence seizures. Epileptic Disorders. 2022 Apr 1;24(2):315-322. doi: 10.1684/epd.2021.1392

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Vlachou, Maria ; Skrimpas, Georgios Alexandros ; Kural, Mustafa Aykut et al. / Electroclinical features and long-term therapeutic response in patients with typical absence seizures. In: Epileptic Disorders. 2022 ; Vol. 24, No. 2. pp. 315-322.

Bibtex

@article{2643aa2c47334668a874c31c38487aec,
title = "Electroclinical features and long-term therapeutic response in patients with typical absence seizures",
abstract = "OBJECTIVE: To characterize in detail the electroclinical features of typical absence seizures and elucidate whether EEG or semiology features, alone or in combination, can predict long-term therapeutic outcome. METHODS: We analysed video-EEG recordings from 213 typical absence seizures from 61 patients with idiopathic generalized epilepsy. We extracted semiological features, in addition to hallmark manifestations (motor/behavioural arrest, non-responsiveness), their location, timing and frequency. We evaluated the duration and frequency of generalized spike-wave discharges and the presence of polyspikes. We used a supervised machine-learning approach (random forest) to search for classifier features for long-term therapeutic outcome (>one year). RESULTS: Besides the hallmark manifestations, additional semiological features were identified in 87% of patients (75% of seizures). The most common additional semiological features were automatisms and eye blinking (observed in 45% and 41.5% of seizures, respectively). Automatisms were associated with longer seizure duration, and oral automatisms occurred earlier compared to limb automatisms (4.03 vs. 6.19 seconds; p=0.005). The mean duration of the ictal spike-wave discharges was nine seconds, and the median frequency was 3 Hz. Polyspikes occurred in 46 seizures (21.6%), in 19 patients (31%). Median follow-up was five years, and 73% of the patients were seizure-free at the end of the follow-up. None of the semiological features, alone or in combination, were predictors of therapeutic outcome. The only significant classifier was the presence of polyspikes, predicting a non-seizure-free outcome with an accuracy of 73% (95% CI: 70-77%), positive predictive value of 92% (95% CI: 84-98%) and negative predictive value of 60% (95% CI: 39-81%). SIGNIFICANCE: Semiological features, in addition to behavioural arrest and non-responsiveness, are common in typical absence seizures, but they do not predict long-term therapeutic outcome. The presence of polyspikes has a high positive predictive value for unfavourable therapeutic outcome, and their presence should therefore be included when reporting EEGs in patients with typical absence seizures.",
keywords = "EEG, idiopathic generalized epilepsy, long-term therapeutic outcome, machine learning, semiology, typical absence seizure",
author = "Maria Vlachou and Skrimpas, {Georgios Alexandros} and Kural, {Mustafa Aykut} and Gija Rackauskaite and Natalya Nikanorova and Jakob Christensen and Marina Nikanorova and S{\'a}ndor Beniczky",
year = "2022",
month = apr,
day = "1",
doi = "10.1684/epd.2021.1392",
language = "English",
volume = "24",
pages = "315--322",
journal = "Epileptic Disorders",
issn = "1294-9361",
publisher = "JohnLibbey Eurotext",
number = "2",

}

RIS

TY - JOUR

T1 - Electroclinical features and long-term therapeutic response in patients with typical absence seizures

AU - Vlachou, Maria

AU - Skrimpas, Georgios Alexandros

AU - Kural, Mustafa Aykut

AU - Rackauskaite, Gija

AU - Nikanorova, Natalya

AU - Christensen, Jakob

AU - Nikanorova, Marina

AU - Beniczky, Sándor

PY - 2022/4/1

Y1 - 2022/4/1

N2 - OBJECTIVE: To characterize in detail the electroclinical features of typical absence seizures and elucidate whether EEG or semiology features, alone or in combination, can predict long-term therapeutic outcome. METHODS: We analysed video-EEG recordings from 213 typical absence seizures from 61 patients with idiopathic generalized epilepsy. We extracted semiological features, in addition to hallmark manifestations (motor/behavioural arrest, non-responsiveness), their location, timing and frequency. We evaluated the duration and frequency of generalized spike-wave discharges and the presence of polyspikes. We used a supervised machine-learning approach (random forest) to search for classifier features for long-term therapeutic outcome (>one year). RESULTS: Besides the hallmark manifestations, additional semiological features were identified in 87% of patients (75% of seizures). The most common additional semiological features were automatisms and eye blinking (observed in 45% and 41.5% of seizures, respectively). Automatisms were associated with longer seizure duration, and oral automatisms occurred earlier compared to limb automatisms (4.03 vs. 6.19 seconds; p=0.005). The mean duration of the ictal spike-wave discharges was nine seconds, and the median frequency was 3 Hz. Polyspikes occurred in 46 seizures (21.6%), in 19 patients (31%). Median follow-up was five years, and 73% of the patients were seizure-free at the end of the follow-up. None of the semiological features, alone or in combination, were predictors of therapeutic outcome. The only significant classifier was the presence of polyspikes, predicting a non-seizure-free outcome with an accuracy of 73% (95% CI: 70-77%), positive predictive value of 92% (95% CI: 84-98%) and negative predictive value of 60% (95% CI: 39-81%). SIGNIFICANCE: Semiological features, in addition to behavioural arrest and non-responsiveness, are common in typical absence seizures, but they do not predict long-term therapeutic outcome. The presence of polyspikes has a high positive predictive value for unfavourable therapeutic outcome, and their presence should therefore be included when reporting EEGs in patients with typical absence seizures.

AB - OBJECTIVE: To characterize in detail the electroclinical features of typical absence seizures and elucidate whether EEG or semiology features, alone or in combination, can predict long-term therapeutic outcome. METHODS: We analysed video-EEG recordings from 213 typical absence seizures from 61 patients with idiopathic generalized epilepsy. We extracted semiological features, in addition to hallmark manifestations (motor/behavioural arrest, non-responsiveness), their location, timing and frequency. We evaluated the duration and frequency of generalized spike-wave discharges and the presence of polyspikes. We used a supervised machine-learning approach (random forest) to search for classifier features for long-term therapeutic outcome (>one year). RESULTS: Besides the hallmark manifestations, additional semiological features were identified in 87% of patients (75% of seizures). The most common additional semiological features were automatisms and eye blinking (observed in 45% and 41.5% of seizures, respectively). Automatisms were associated with longer seizure duration, and oral automatisms occurred earlier compared to limb automatisms (4.03 vs. 6.19 seconds; p=0.005). The mean duration of the ictal spike-wave discharges was nine seconds, and the median frequency was 3 Hz. Polyspikes occurred in 46 seizures (21.6%), in 19 patients (31%). Median follow-up was five years, and 73% of the patients were seizure-free at the end of the follow-up. None of the semiological features, alone or in combination, were predictors of therapeutic outcome. The only significant classifier was the presence of polyspikes, predicting a non-seizure-free outcome with an accuracy of 73% (95% CI: 70-77%), positive predictive value of 92% (95% CI: 84-98%) and negative predictive value of 60% (95% CI: 39-81%). SIGNIFICANCE: Semiological features, in addition to behavioural arrest and non-responsiveness, are common in typical absence seizures, but they do not predict long-term therapeutic outcome. The presence of polyspikes has a high positive predictive value for unfavourable therapeutic outcome, and their presence should therefore be included when reporting EEGs in patients with typical absence seizures.

KW - EEG

KW - idiopathic generalized epilepsy

KW - long-term therapeutic outcome

KW - machine learning

KW - semiology

KW - typical absence seizure

UR - http://www.scopus.com/inward/record.url?scp=85130862513&partnerID=8YFLogxK

U2 - 10.1684/epd.2021.1392

DO - 10.1684/epd.2021.1392

M3 - Journal article

C2 - 34859792

AN - SCOPUS:85130862513

VL - 24

SP - 315

EP - 322

JO - Epileptic Disorders

JF - Epileptic Disorders

SN - 1294-9361

IS - 2

ER -