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Title: Predicting seizure control: cortical excitability and antiepileptic medication.
Austin Authors: Badawy, Radwa A B;Macdonell, Richard A L ;Berkovic, Samuel F ;Newton, Mark R;Jackson, Graeme D 
Affiliation: Department of Neurology, Austin Health, Heidelberg, Victoria, Australia
Issue Date: 1-Jan-2010
Publication information: Annals of Neurology; 67(1): 64-73
Abstract: Approximately 30% of patients with newly diagnosed epilepsy do not respond to antiepileptic drugs (AEDs), but this is not predictable. We used transcranial magnetic stimulation to determine the effect of AEDs on cortical excitability in patients with epilepsy and correlated this with a successful response to treatment.Ninety-nine drug-naïve patients with newly diagnosed epilepsy (55 idiopathic generalized epilepsy, 44 focal epilepsy) were evaluated. Motor threshold and cortical excitability on recovery curve analysis were measured before and 4 to 16 weeks after starting medication. After 1 year of treatment, 43 of 55 idiopathic generalized epilepsy and 26 of 44 focal epilepsy patients were seizure free.A decrease in cortical excitability occurred in the seizure-free group as indicated by an increase in motor threshold (p < 0.05) and intracortical inhibition on recovery curve analysis, maximum at the 250-millisecond interstimulus interval (p < 0.01) compared with pretreatment values. These changes were not present in the group with ongoing seizures.Seizure freedom is marked by a reduction in transcranial magnetic stimulation measures of cortical excitability, evident shortly after beginning therapy. This virtual normalization of cortical excitability occurred regardless of the seizure characteristics or AED used. Failure to show this response to AED treatment may be valuable as an early predictor of pharmacoresistance in individual patients.
Gov't Doc #: 20186859
DOI: 10.1002/ana.21806
Journal: Annals of Neurology
Type: Journal Article
Subjects: Adolescent
Anticonvulsants.therapeutic use
Brain.drug effects.physiopathology
Cohort Studies
Epilepsies, Partial.diagnosis.drug therapy.physiopathology
Epilepsy, Generalized.diagnosis.drug therapy.physiopathology
Evoked Potentials, Motor.drug effects
Follow-Up Studies
Functional Laterality
Middle Aged
Seizures.diagnosis.drug therapy.physiopathology
Time Factors
Transcranial Magnetic Stimulation.methods
Treatment Outcome
Young Adult
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