OBJECTIVE This study was undertaken to evaluate the influence that subject-specific factors have on intracranial interictal epileptiform discharge (IED) rates in persons with refractory epilepsy. METHODS One hundred fifty subjects with intracranial electrodes performed multiple sessions of a free recall memory task; this standardized task controlled for subject attention levels. We utilized a dominance analysis to rank the importance of subject-specific factors based on their relative influence on IED rates. Linear mixed-effects models were employed to comprehensively examine factors with highly ranked importance. RESULTS Antiseizure medication (ASM) status, time of testing, and seizure onset zone (SOZ) location were the highest-ranking factors in terms of their impact on IED rates. The average IED rate of electrodes in SOZs was 34% higher than the average IED rate of electrodes outside of SOZs (non-SOZ; p < .001). However, non-SOZ electrodes had similar IED rates regardless of the subject's SOZ location (p = .99). Subjects on older generation (p < .001) and combined generation (p < .001) ASM regimens had significantly lower IED rates relative to the group taking no ASMs; newer generation ASM regimens demonstrated a nonsignificant association with IED rates (p = .13). Of the ASMs included in this study, the following ASMs were associated with significant reductions in IED rates: levetiracetam (p < .001), carbamazepine (p < .001), lacosamide (p = .03), zonisamide (p = .01), lamotrigine (p = .03), phenytoin (p = .03), and topiramate (p = .01). We observed a nonsignificant association between time of testing and IED rates (morning-afternoon p = .15, morning-evening p = .85, afternoon-evening p = .26). SIGNIFICANCE The current study ranks the relative influence that subject-specific factors have on IED rates and highlights the importance of considering certain factors, such as SOZ location and ASM status, when analyzing IEDs for clinical or research purposes.

中文翻译：

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难治性癫痫颅内发作间期癫痫样放电的相关因素

目的 本研究旨在评估受试者特定因素对难治性癫痫患者颅内发作间期癫痫样放电 (IED) 率的影响。方法 150 名具有颅内电极的受试者进行了多次自由回忆记忆任务；这个标准化的任务控制了受试者的注意力水平。我们利用优势分析根据特定主题因素对 IED 率的相对影响对它们的重要性进行排名。采用线性混合效应模型全面检查具有高度重要性的因素。结果 抗癫痫药物 (ASM) 状态、测试时间和癫痫发作起始区 (SOZ) 位置是影响简易爆炸装置发生率的最高级别因素。SOZ 中电极的平均 IED 率比 SOZ 外电极的平均 IED 率高 34%（非 SOZ；p < .001）。然而，无论受试者的 SOZ 位置如何，非 SOZ 电极的 IED 率都相似 (p = .99)。与未服用 ASM 的组相比，使用老一代 (p < .001) 和联合一代 (p < .001) ASM 方案的受试者的 IED 发生率显着降低；新一代 ASM 方案与 IED 发生率无显着相关性 (p = .13)。在本研究中纳入的 ASM 中，以下 ASM 与 IED 率显着降低相关：左乙拉西坦 (p < .001)、卡马西平 (p < .001)、拉考沙胺 (p = .03)、唑尼沙胺 (p = .01 )、拉莫三嗪 (p = .03)、苯妥英 (p = .03) 和托吡酯 (p = .01)。我们观察到测试时间与 IED 率之间无显着关联（早 - 午 p = .15，早 - 晚 p = .85，午 - 晚 p = .26）。意义 当前研究对特定主题因素对 IED 率的相对影响进行了排名，并强调了在为临床或研究目的分析 IED 时考虑某些因素的重要性，例如 SOZ 位置和 ASM 状态。