Abstract:

Background:The search for biomarkers that can inform medication decisions inneuropsychiatric disorders is a goal of the Research Domain Criteria projectunder the National Institute of Mental Health. Isolated epileptiform discharges(IEDs) may be such a biomarker. IEDs have been linked to increasedpsychopathology that traverses many diagnoses [1]. It has been suggested thatIEDs may represent an epiphenomenon with an etiology of unappreciatedsignificance [2]. The literature suggests that anticonvulsants should beconsidered when IEDs are identified [3, 4]; however, outcome studies have yetto be published. This study investigates the predictive value of IEDs as abiomarker for the use of anticonvulsants on a large cohort of patients.

Method:‍

We reviewed refractory cases from a large multidisciplinary practice whose EEGreadings contained IEDs and were subsequently medicated with anticonvulsants bythe clinic’s psychiatrist. The psychiatrist’s follow up progress notes wereassessed to determine the impact of adding anticonvulsants. Ratings were basedon clinical presentation and reported in three categories: Improved, unchanged,and more severe. There were two exclusion criteria: a prior diagnosis ofseizure disorder and a history of prior treatment with anticonvulsants. Of the735 patients in our database, 325 (44.22%) were identified with IEDs. The finalsample was comprised of 76 refractory cases. The study included 61 males(80.26%) and 15 females (19.74%) ages 5 to 52.