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The following is a summary of “Comprehensive predictors of drug-resistant epilepsy in MELAS: clinical, EEG, imaging, and biochemical factors,” published in the February 2025 issue of BMC Neurology by Gao et al. 

Researchers conducted a retrospective study to identify factors associated with drug-resistant epilepsy in Mitochondrial Encephalomyopathy, Lactic Acidosis, and Stroke-Like Episodes (MELAS). Clinical, Electroencephalography (EEG), imaging, and biochemical factors were analyzed for their predictive role. 

They conducted a single-center retrospective study to investigate the clinical characteristics of seizures in patients with MELAS. Data on clinical features, muscle biopsy results, genetic testing, seizure symptoms, EEG, neuroimaging findings, cerebrospinal fluid and blood biochemistry, and the modified Rankin Scale (mRS) were collected. They also analyzed the correlation between seizure frequency and mRS scores and examined the risk factors for drug-resistant epilepsy in MELAS. 

The results showed that 37 patients with MELAS (24 males, 13 females) experienced seizures, with onset ages ranging from 14 to 53 years (mean 32 years). Generalized seizures were the most common, and EEG revealed background rhythm abnormalities in all patients, with epileptiform discharges in 37.8%. Status epilepticus (OR 16.499; 95% CI, 1.615–168.557; P = 0.018) and elevated resting serum lactate levels (OR 8.594; 95% CI, 1.342–59.733; P = 0.024) were independent risk factors for drug-resistant epilepsy. Seizure frequency changes at follow-up correlated with the mRS score (r = 0.533, P < 0.001). 

Investigators found that status epilepticus and elevated resting serum lactate levels were predictive of drug-resistant epilepsy in MELAS. Poor seizure control was significantly associated with increased clinical disability. 

Source: bmcneurol.biomedcentral.com/articles/10.1186/s12883-025-04046-2