Investigating short-term antiseizure medication effects on interictal epileptiform discharges in idiopathic
Clemens Lang1, Tamara Lisy1, Gerhard Gritsch2
1Department of Neurology, Clinic Hietzing, Vienna, Austria; Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Vienna, Austria.
Objective:
To quantify short-term antiseizure medication (ASM) effects on interictal epileptiform discharge (IED) rates during long-term video-EEG monitoring (LT-VEM) in idiopathic generalized epilepsy (IGE) using pharmacokinetic modeling and automated IED detection.
Methods:
In a retrospective cohort of 38 IGE patients undergoing LT-VEM with ASM tapering (January 2010-December 2024), we applied AI-based hybrid IED detection and first-order pharmacokinetic modeling to calculate hourly normalized IED rates and cumulative DDD-normalized ASM drug-load profiles. We compared each patient's IED rate between their lowest- and highest-load 24-hour windows using paired t-tests in the full cohort and in a benzodiazepine-naïve subgroup.
Results:
IED rate was reduced by a median 63.6% (IQR 17.8-92.3%) between each patient's lowest- and highest-load 24-hour windows (p < 0.001; Cohen's d = - 0.81, 95% CI - 1.24 to - 0.37). The effect was preserved in the benzodiazepine-naïve subgroup (n = 18; p = 0.007; Cohen's d = - 0.84, 95% CI - 1.48 to - 0.19), ruling out acute benzodiazepine-induced effects as the driver.
Conclusions:
Pharmacokinetic modeling combined with automated IED quantification demonstrates a large, robust short-term ASM effect on IED rates in IGE across a multi-day monitoring scale.
Significance:
These findings support IED quantification as a candidate neurophysiological biomarker for individualized treatment response assessment.
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