Semiological Differences Between Women and Men with Focal Epilepsy Are Influenced by Sex-specific Syndrome Prevalences
Abstract number :
3.356
Submission category :
4. Clinical Epilepsy / 4E. Women's Issues
Year :
2024
Submission ID :
368
Source :
www.aesnet.org
Presentation date :
12/9/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Nicholas Fearns, MD – University Hospital, LMU Munich
Max Jung, Student – University Hospital, LMU Munich
Paula Albert i Gracenea, MD – University Hospital, LMU Munich
Anne Nack, MD – University Hospital, LMU Munich
Nedda Hansel, Student – University Hospital, LMU Munich
Jan Remi, MD – University Hospital of Munich (LMU)
Elisabeth Kaufmann, MD – Ludwig-Maximilan's University, Munich
Christian Vollmar, PhD, MD – University Hospital of Munich (LMU)
Rationale: Seizure semiology plays an important role in the localization of the epileptogenic zone during presurgical evaluation of epilepsy. Few data are available on sex-specific differences both in semiology as well as syndrome prevalence and how these affect the localizing significance. The present study highlights both semiological and syndromic differences between the sexes and their interplay.
Methods: Adult patients who underwent video-EEG-monitoring (VEM) between 1994 and 2024 and had at least one seizure were included retrospectively from the Ludwig Maximilan University Munich Epilepsy Center’s database. Firstly, the prevalence of different epilepsy syndromes was analysed by sex. Secondly, seizure semiology was analysed in terms of syndrome and sex. For the latter, only patients with unilobar and bifrontal epilepsy were included. To achieve comparable syndrome specific group sizes, the semiology analysis was limited to 2010 to 2024 in temporal lobe epilepsy (TLE) patients.
Results: In the entire cohort (773 patients, 383 female), there was a significant sex-specific difference in TLE compared to frontal lobe epilepsy (FLE) prevalence. TLE prevalence was 49% in women compared to 43% in men, while FLE prevalence was 17% in women, compared to 24% in men (p=0.011). For semiology analysis, a total of 4845 seizures in 384 patients (195 female) was evaluated. In this group, sex-specific syndrome prevalence also differed significantly between women and men, with TLE being more prevalent in women (W: 63%, M:49%) and FLE being more prevalent in men (W: 26%, M: 38%) (p=0.006).
Further, men had more simple motor (tonic and clonic) seizures (W: 33% (n=64), M: 43% (n=81), p=0.043), focal to bilateral tonic clonic seizures (W: 43% (n=83), M: 59% (n=111), p=0.0015) and versive seizures (W: 25% (n=48), M: 45% (n=85), p< 0.0001). Women, on the other hand, had more auras (W: 62% (n=121), M: 46% (n=86), p=0.001) and automotor seizures (W: 65% (n=126), M:52% (n=99), p=0.015).
When corrected for epilepsy syndrome, semiology differences could not be shown for simple motor and automotor seizures. Focal to bilateral tonic clonic seizures (FBTCS) were only more frequent in men with TLE, not extra-TLE. Versive seizures were still more prevalent in men and auras were still more frequent in women.
Conclusions: Focal epilepsy syndrome prevalence differs in men and women, reflecting also in sex-specific differences in seizure semiology. After correction for the different syndrome prevalence, men with TLE still had a higher percentage of FTBCS and independent of syndrome less frequently auras, indicating sex-specific differences in seizure inhibition and propagation. Further studies in larger multicentric cohorts should corroborate these findings.
Funding: None
Clinical Epilepsy