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Focal symptoms may be prognostic in generalised epilepsies

Focal symptoms may be prognostic in generalised epilepsies

By Eleanor McDermid, Senior medwireNews Reporter

fd7320c1b34017c06da8dde1d37a8b62Symptoms consistent with focal seizures are often reported by patients who have idiopathic generalized epilepsies (IGE) and are associated with a short duration of freedom from seizures, say researchers.

This strong association remained significant after accounting for a number of confounders, including age at onset, duration of epilepsy and the presence of generalized tonic–clonic seizures. The 95% confidence interval did cross zero after adjustment for some confounders, such as the number of antiepileptic drugs used, but the team attributes this to the relatively small sample size, and stresses the clinical relevance of the association.

“Overall, our study raises the possibility that the presence of [focal seizure symptoms] may be an important prognostic factor associated with the duration of seizure freedom”, they write in Neurology.

Over-reliance on focal symptoms when classifying epilepsy “may have far-reaching consequences such as unnecessary investigations, delayed diagnosis, misdiagnosis, and the use of inappropriate antiepileptic drugs”, say Udaya Seneviratne (St Vincent’s Hospital, Melbourne, Australia) and study co-authors.

They add: “Hence, we emphasize the critical role of EEG in the confirmation of diagnosis of IGE.”

The most common focal seizure symptom was aphasia, reported by 24.4% of the patients, followed by visual effects, at 17.8%. Other relatively frequent symptoms were visceral/epigastric symptoms, focal tonic/clonic/myoclonic symptoms, automatisms, and auditory and somatosensory symptoms, reported by between 7% and 12% of the patients.

Of note, these symptoms were as frequent in patients with minor seizures – absence or myoclonic seizures – as they were in those with generalised tonic–clonic seizures.

In a related commentary, J Craig Henry (Winchester Neurological Consultants, Virginia, USA) observes: “The notion that focal seizure symptoms definitively identify focal-onset seizures appears to be dying, if not dead, dogma.”

He says: “Adding to a growing body of literature that is blurring the classic dichotomy of epilepsy syndromes associated with focal- vs generalized-onset seizures, these findings commend circumspection: be careful what you ask for, and particularly careful in what you make of it.”

Licensed from medwireNews with permission from Springer Healthcare Ltd. ©Springer Healthcare Ltd. All rights reserved. Neither of these parties endorse or recommend any commercial products, services, or equipment.

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  1. I am gonna be 49 Aug.2, I have all of these happening to me. I have a lot of confusion on top of it all. Tried an tried to get SSI, been denied. Got a lawyer last year an all he did was sign me up for SSDI, denied. Not enough work credits, this I told him cause I have worked under the table most of my adult life. Just a few months ago same lawyer sends me letter of bankruptcy case, an I have never filed for bankruptcy. I can’t seem to get any help.
    Live with my mother, an we are on our last legs. Bills are piling up , we pay what we can. Always worrying if next month we’ll be homeless. I am stressed an woreout. To many problems to workout, I not sure what to do anymore

  2. Hi I hope you tell sign different between seizures and epilepsy later

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