Altered visual contrast gain control is sensitive for idiopathic generalized epilepsies

•Patients with idiopathic generalized epilepsy (IGE) manifest abnormal gain control to increasing contrast of visual stimuli.•IGE patients were reliably classified from healthy controls based on the contrast responses.•The most discriminating feature was patients' relative lack of gain control at high contrasts.

ObjectiveVisual hyperexcitability in the form of abnormal contrast gain control has been shown in photosensitive epilepsy and idiopathic generalized epilepsies. We assessed the accuracy and reliability of measures of visual contrast gain control in discerning individuals with idiopathic generalized epilepsies from healthy controls.MethodsTwenty-four adult patients with idiopathic generalized epilepsy and 32 neurotypical control subjects from two study sites participated in a prospective, cross-sectional study. We recorded steady-state visual evoked potentials to a wide range of contrasts of a flickering grating stimulus. The resultant response magnitude vs. contrast curves were fitted to a standard model of contrast response function, and the model parameters were used as input features to a linear classifier to separate patients from controls. Additionally we compared the relative contribution of model parameters towards the classification using a sparse feature-selection approach.ResultsClassification accuracy was 80% or better. Sensitivity and specificity both were 80-85%. Cross validation confirmed robust classifier performance generalizable across the data from the two samples. Patients' relative lack of gain control at high contrasts was the most important information distinguishing patients from controls.ConclusionsIndividuals with idiopathic generalized epilepsy were distinguishable from the neurotypical with a high degree of accuracy and reliability by a reduction in gain control at high contrasts.SignificanceGain control is an essential neural operation that regulates neuronal sensitivity to stimuli and may represent a novel biomarker of hyperexcitability.