The impact of anti-seizure medications on electroencephalogram (EEG) results

ABSTRACT

Introduction

Despite recent advances in neuroimaging and genetics, electroencephalography (EEG) continues to play a central role in the diagnosis and management of epilepsy. One application of EEG is called pharmaco-EEG. This technique is highly sensitive in detecting the effects of drugs on brain functioning and shows potential in predicting the efficacy and tolerability of anti-seizure medications (ASMs).

Areas covered

In this narrative review, the authors discuss the most salient data concerning the effects of different ASMs on EEG. The authors aim to provide a clear and concise overview of the current state of research in this area, while also identifying opportunities for future investigation.

Expert opinion

To date, pharmaco-EEG does not appear to be clinically reliable for predicting treatment response in epilepsy, as the literature is limited by underreporting of negative results, a lack of controls in many studies and insufficient direct replication of previous findings. Future research should focus on controlled interventional studies, which are currently lacking.

KEYWORDS:

• Electroencephalography
• Pharmaco-EEG
• epilepsy
• anti-seizure medication
• treatment response

Article highlights

• EEG is considered the gold standard investigation for the diagnosis and management of epilepsy.

• A comprehensive understanding of EEG changes induced by antiseizure medications is essential for proper interpretation of EEG results.

• Treatment with several of the older anti-seizure medications results in substantial changes (slowing or increasing) of EEG background rhythms.

• Pharmaco-EEG is a potential biomarker of therapeutic efficacy and drug-induced neurotoxicity. Unfortunately, the level of evidence is still very low.

• Most pharmaco-EEG studies had severe limitations and only assessed short-term effects in a small number of healthy subjects. Future research should focus on controlled interventional studies, which are currently lacking.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript was not funded.