Elsevier

Epilepsy Research

Volume 164, August 2020, 106353
Epilepsy Research

Predictors of drug-resistance in epilepsy with auditory features

https://doi.org/10.1016/j.eplepsyres.2020.106353Get rights and content

Highlights

  • Two positive predictors of drug-resistance, age at seizure onset < or = 10 and seizures during sleep, were found in epilepsy with auditory features.

  • Early use of oxcarbazepine is a negative predictor of drug-resistance.

  • As the second or later antiepileptic drug in epilepsy with auditory features, oxcarbazepine could not be a protective predictor of drug-resistance.

Abstract

Objective

To investigate predictors of drug-resistance in epilepsy with auditory features (EAF).

Methods

Drug-resistant epilepsy (DRE) was defined according to International League Against Epilepsy guidelines. For univariate analysis, the chi-squared, Fisher’s exact, and Mann-Whitney test were used. Odds ratios (OR) and 95% confidence intervals (CIs) of predictors were estimated by logistic regression analyses.

Results

A total of 107 patients (52 male) between the ages of 13.0 and 78.8 years were included in this cohort. In univariate analysis, ten variables, including age at seizure onset < or = 10 years, febrile seizures, psychiatric disorders, seizures during sleep, multiple first ictal symptoms, electroencephalogram epileptiform discharges during waking, non-specific abnormalities in electroencephalogram, oxcarbazepine as the first drug, oxcarbazepine in the first two drugs and valproic acid in the first two drugs, showed possibilities as prognostic factors of EAF (p < 0.10). After logistic regression analyses, two positive predictors of drug-resistance, including age at seizures onset < or = 10 (OR = 6.37, 95% CI = 1.08–37.7, p = 0.041) and seizures during sleep (OR = 4.42, 95% CI = 1.45–13.48, p = 0.009) were found. Oxcarbazepine as the first AED is a negative predictive factor of drug-resistance (OR = 0.22, 95% CI = 0.06–0.84, p = 0.027).

Conclusions

Three predictors may help early diagnosis of DRE in EAF. Early use of oxcarbazepine is a negative predictor of drug-resistance, which may provide an intervention point to minimize the risk of drug-resistance.

Introduction

Epilepsy with auditory features (EAF) accounts for approximately 1% of all people with epilepsy, characterized by seizures with auditory or aphasic symptoms, negative neuroimaging findings in most patients, and high probability to generalize (Bisulli et al., 2018; Florindo et al., 2006; Pippucci et al., 2015). A recent study suggested that seizure free is difficult to sustain long-term in EAF (Bisulli et al., 2018). Only 34% of the EAF patients achieved five seizure-free years (Bisulli et al., 2018). It remains difficult to avoid drug-resistance in EAF. Investigating predicting factors of drug-resistance may provide more effective treatment regimens in EAF.

However, few studies have focused on drug-resistant epilepsy (DRE) predictors in EAF. Only one study with >100 patients investigated the predictors of seizure freedom (Bisulli et al., 2018). In addition, it remains unclear whether antiepileptic drugs (AEDs) are the predictors of drug-resistance in EAF. More studies are needed to systematically address DRE predictors of EAF. In this study, we investigated the risk factors that may be early predictors of drug-resistance and expected that these risk factors might provide an intervention point to minimize the risk of drug-resistance in EAF.

Section snippets

Study design and participants

This study has a retrospective cohort design, approved by the Ethics Committee of the West China Hospital of Sichuan University. We reviewed medical records of all consecutive patients with auditory symptoms and/or receptive aphasia, referred to the Epilepsy Center of West China Hospital between 2009 and 2019. Inclusion criteria: patients with (1) confirmed diagnosis of epilepsy according to International League Against Epilepsy (Fisher et al., 2014), (2) at least 2 epileptic seizures with

Subject identification and comparison of the clinical features

The selection process is shown in Fig. 1. A total of 107 patients with EAF were included, and 48.6% of them were diagnosed as DRE. Among them, 48.6% were male, and the average age was 29.2 years, with a range of 13.0–78.8 years. The minimum duration of follow-up was 1.6 years. It was likely inherited as an autosomal-dominant trait for 8 patients with family history. No causative variant was identified. Four patients underwent surgery.

The characteristics of the included patients and univariate

Discussion

In the present study, the focus was on the predictors of drug-resistance in EAF. The main findings were as follows: (1) approximately half of EAF patients were diagnosed as DRE; (2) age at seizure onset < or = 10 and seizures during sleep were positive predictive factors of drug-resistance; (3) oxcarbazepine as the first AED is a protect predictor of drug-resistance in EAF.

Another similar study evaluated the prognostic factors in a large cohort of EAF patients, which suggested that age at onset

Conclusion

Our study suggests that three predictors, age at seizure onset <10 years, the first AEDs, and seizures during sleep may aid in early diagnosis of drug-resistance in EAF. The most meaningful predictor associated with drug-resistance in this cohort appears to be the first AEDs. Our study supports that early use of oxcarbazepine is a negative predictor of drug-resistance, which provides an intervention point to minimize the risk of drug-resistance in EAF. However, due to the small sample and

Declaration of Competing Interest

The authors declare no financial or other conflicts of interest.

Acknowledgements

This work was supported by National Nature Science Foundation of China (No. 81871018).

References (15)

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