Department of Neurology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.
Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
Epilepsia. 2021 Feb;62(2):481-491. doi: 10.1111/epi.16792. Epub 2020 Dec 17.
This study was undertaken to evaluate the influence that subject-specific factors have on intracranial interictal epileptiform discharge (IED) rates in persons with refractory epilepsy.
One hundred fifty subjects with intracranial electrodes performed multiple sessions of a free recall memory task; this standardized task controlled for subject attention levels. We utilized a dominance analysis to rank the importance of subject-specific factors based on their relative influence on IED rates. Linear mixed-effects models were employed to comprehensively examine factors with highly ranked importance.
Antiseizure medication (ASM) status, time of testing, and seizure onset zone (SOZ) location were the highest-ranking factors in terms of their impact on IED rates. The average IED rate of electrodes in SOZs was 34% higher than the average IED rate of electrodes outside of SOZs (non-SOZ; p < .001). However, non-SOZ electrodes had similar IED rates regardless of the subject's SOZ location (p = .99). Subjects on older generation (p < .001) and combined generation (p < .001) ASM regimens had significantly lower IED rates relative to the group taking no ASMs; newer generation ASM regimens demonstrated a nonsignificant association with IED rates (p = .13). Of the ASMs included in this study, the following ASMs were associated with significant reductions in IED rates: levetiracetam (p < .001), carbamazepine (p < .001), lacosamide (p = .03), zonisamide (p = .01), lamotrigine (p = .03), phenytoin (p = .03), and topiramate (p = .01). We observed a nonsignificant association between time of testing and IED rates (morning-afternoon p = .15, morning-evening p = .85, afternoon-evening p = .26).
The current study ranks the relative influence that subject-specific factors have on IED rates and highlights the importance of considering certain factors, such as SOZ location and ASM status, when analyzing IEDs for clinical or research purposes.
本研究旨在评估个体特有的因素对难治性癫痫患者颅内癫痫样放电（IED）率的影响。
150 名接受颅内电极的受试者进行了多次自由回忆记忆任务；该标准化任务控制了受试者的注意力水平。我们利用优势分析根据其对 IED 率的相对影响来对个体特有的因素进行排名。线性混合效应模型用于全面检查具有高排名重要性的因素。
抗癫痫药物（ASM）状态、测试时间和致痫区（SOZ）位置是影响 IED 率的最重要因素。SOZ 内电极的平均 IED 率比 SOZ 外电极（非 SOZ）高 34%（p < 0.001）。然而，非 SOZ 电极的 IED 率与受试者的 SOZ 位置无关（p = 0.99）。服用第一代（p < 0.001）和联合代（p < 0.001）ASM 方案的受试者的 IED 率明显低于未服用 ASM 的组；而新一代 ASM 方案与 IED 率无显著相关性（p = 0.13）。在本研究中包含的 ASM 中，以下 ASM 与 IED 率的显著降低相关：左乙拉西坦（p < 0.001）、卡马西平（p < 0.001）、拉科酰胺（p = 0.03）、唑尼沙胺（p = 0.01）、拉莫三嗪（p = 0.03）、苯妥英钠（p = 0.03）和托吡酯（p = 0.01）。我们观察到测试时间与 IED 率之间无显著相关性（上午-下午 p = 0.15，上午-晚上 p = 0.85，下午-晚上 p = 0.26）。
本研究对个体特有的因素对 IED 率的相对影响进行了排名，并强调了在分析临床或研究目的的 IED 时考虑某些因素（如 SOZ 位置和 ASM 状态）的重要性。
