Abstracts

Rationale: Primary generalized epilepsy (PGE) is a condition associated to a good response to treatment with antiepileptic drugs (AED). However, daily clinical practice shows a number of patients with this condition that do not achieve a satisfactory seizures control. Therefore, the endpoint is to identify clinical features related with refractoriness in PGE as a whole group and, separately, in its mainly epileptic syndromes, namely, PGE with generalized tonic-clonic seizures (GTCS) only, absence epilepsy (AE) and juvenile myoclonic epilepsy (JME). Methods: We retrospectively studied a cohort of 100 consecutive patients with PGE assessed in our Outpatient Clinic. Data were obtained from medical records. According to the proposal of International League Against Epilepsy (ILAE), which defines drug-resistant epilepsy as a failure of 2 adequate trials of appropriately chosen AED schedules3, we classified patients in two groups: those drug-resistants called refractory and those with good response, called responder . Several clinical features were compared through a statistical analysis performed with the Statistical Package for the Social Sciences (SPSS) version 16.0; P values of 0.05 were regarded as significant.Results: There were 64 refractory and 36 responder patients, from whom 67 were females. Forty-eight patients had PGE with GTCS only, 26 AE and 26 JME. Refractory patients were older (35.1 vs 27.6 years), with an earlier seizure onset (12 vs 16 years) and longer duration of epilepsy (21 vs 7 years). Clinical features associated with refractoriness were length of the disease (P<0.01), having more than one type of seizure (GTCS, absences or myoclonic jerks; P=0.03), presence of generalized polyspikes in the EEG (P=0.05), and presence of AED-related side effects (P<0.05). Additionally, 36 out of 43 refractory patients were able to identify certain lifestyle changes as seizure triggers. Otherwise, up to 46.9% (30/64) of refractory patients had a psychiatric disorder associated, mainly depression (17/30; 56.7%).Conclusions: Refractoriness in patients with PGE appears to be associated with clinical (duration of epilepsy, seizure types), electrographic (polyspikes) and therapeutic (AED intolerance) parameters. These parameters are not modifiable for epileptologists. Nevertheless, lifestyle advices and appropriate seek and management of psychiatric disorders can lead these patients to a better seizure control and increased quality of life.