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OBJECTIVE: We sought to determine which combination of clinical and electroencephalography (EEG) characteristics differentiate between an antiseizure medication (ASM)-resistant vs ASM-responsive outcome for patients with idiopathic generalized epilepsy (IGE). METHODS: This was a case-control study of ASM-resistant cases and ASM-responsive controls with IGE treated at five epilepsy centers in the United States and Australia between 2002 and 2018. We recorded clinical characteristics and findings from the first available EEG study for each patient. We then compared characteristics of cases vs controls using multivariable logistic regression to develop a predictive model of ASM-resistant IGE. RESULTS: We identified 118 ASM-resistant cases and 114 ASM-responsive controls with IGE. First, we confirmed our recent finding that catamenial epilepsy is associated with ASM-resistant IGE (odds ratio [OR] 3.53, 95% confidence interval [CI] 1.32-10.41, for all study subjects) after covariate adjustment. Other independent factors seen with ASM resistance include certain seizure-type combinations (absence, myoclonic, and generalized tonic-clonic seizures [OR 7.06, 95% CI 2.55-20.96]; absence and generalized tonic-clonic seizures [OR 4.45, 95% CI 1.84-11.34]), as well as EEG markers of increased generalized spike-wave discharges (GSWs) in sleep (OR 3.43, 95% CI 1.12-11.36 for frequent and OR 7.21, 95% CI 1.50-54.07 for abundant discharges in sleep) and the presence of generalized polyspike trains (GPTs; OR 5.49, 95% CI 1.27-38.69). The discriminative ability of our final multivariable model, as measured by area under the receiver-operating characteristic curve, was 0.80. SIGNIFICANCE: Multiple clinical and EEG characteristics independently predict ASM resistance in IGE. To improve understanding of a patient's prognosis, clinicians could consider asking about specific seizure-type combinations and track whether they experience catamenial epilepsy. Obtaining prolonged EEG studies to r

In line with expanded conceptualizations of validity that encompass the interpretations and uses of test scores in particular policy contexts, this report presents results of a comparative analysis of institutional understandings and uses of 3 international English proficiency tests widely used for tertiary selection—the TOEFL iBT® test, the International English Language Testing Service (IELTS; Academic), and the Pearson Test of English (PTE)—at 2 major research universities, 1 in the United States and the other in Australia. Adopting an instrumental case study approach, the study investigated levels of knowledge about and uses of test scores in international graduate student admissions procedures by key stakeholders at Purdue University and the University of Melbourne. Data for the study were gathered via a questionnaire eliciting fixed‐choice responses and supplemented with qualitative interview data querying the basis for participants' beliefs, understandings, and practices. The study found that the primary use of language‐proficiency test scores, whether TOEFL®, IELTS, or PTE, by those involved in the admissions process at both institutions was often limited to determining whether applicants had met the institutional cutoff for admission. Beyond this focused and arguably narrow use, language‐proficiency test scores had little impact on admissions decisions, which largely depended on other required elements of applicants' admissions files. In addition, and despite applicants having submitted test scores that met the required cutoffs, survey respondents and interviewees often indicated dissatisfaction with enrolled students' levels of English‐language proficiency, both for academic study and for other roles within the university and in subsequent employment. A slight majority at both institutions indicated that they believed the institutional cutoffs represented adequate proficiency, while the remainder indicated that they believed the cutoffs represented minimal