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Factors associated with tonic-clonic seizures in patients with drug-resistant mesial temporal epilepsy
Ali A Asadi-Pooya1, Cyrus Rostami1, Amin H Rabiei1
1Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Purpose:
Among different seizure types, tonic-clonic seizures are more significant because they are more often associated with morbidity. No prior study has been done to investigate risk factors associated with tonic-clonic seizures in patients with mesial temporal epilepsy.
Methods:
In this retrospective study, all drug-resistant mesial temporal epilepsy patients in the database of patients who underwent epilepsy surgery at Jefferson comprehensive epilepsy center were recruited. These patients were prospectively registered in a database from 1986 till 2014. Patients' age, gender, epilepsy risk factors, age at seizure onset, and preoperative seizure type(s) were registered routinely. Potential risk factors associated with experiencing preoperative tonic-clonic seizures were investigated.
Results:
Two hundred seventy-five patients (132 males and 143 females) were studied. Aura type was associated with experiencing perioperative tonic-clonic seizures. Patients with epigastric auras less frequently reported having tonic-clonic seizures compared with those who had other types of auras (odds ratio: 0.37 and 95% confidence interval: 0.19-0.70; p=0.001) and those who did not have any auras (odds ratio: 0.35 and 95% confidence interval: 0.16-0.77; p=0.008).
Conclusion:
Epigastric auras may indicate that a specific anatomic location is involved in epileptogenesis from which generalization is harder because of that location's poor connections with other brain regions.
Insights
In mesial temporal epilepsy, epigastric auras are linked to fewer tonic-clonic seizures. This suggests specific brain regions involved in these auras may resist seizure generalization.
Area of Science:
- Neurology
- Epileptology
- Clinical Neuroscience
Background:
- Tonic-clonic seizures are a significant concern in epilepsy due to their association with increased morbidity.
- Mesial temporal epilepsy is a common epilepsy syndrome, often drug-resistant.
- Risk factors for tonic-clonic seizures in mesial temporal epilepsy remain under-investigated.
Purpose of the Study:
- To identify risk factors associated with tonic-clonic seizures in patients with drug-resistant mesial temporal epilepsy.
- To investigate the relationship between aura type and the occurrence of tonic-clonic seizures.
Main Methods:
- Retrospective analysis of drug-resistant mesial temporal epilepsy patients who underwent epilepsy surgery.
- Data collected prospectively from 1986-2014, including demographics, epilepsy history, and seizure types.
- Statistical analysis to determine risk factors for preoperative tonic-clonic seizures.
Main Results:
- The study included 275 patients (132 males, 143 females).
- Aura type was significantly associated with perioperative tonic-clonic seizures.
- Patients with epigastric auras reported tonic-clonic seizures less frequently than those with other auras or no auras (OR 0.37, P=0.001; OR 0.35, P=0.008).
Conclusions:
- Epigastric auras may signify involvement of brain regions with limited connectivity, potentially hindering seizure generalization.
- This finding could inform understanding of seizure propagation pathways in mesial temporal epilepsy.
- Further research into the neuroanatomical basis of aura-related seizure control is warranted.
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