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Published on: September 20, 2024
Epileptic disorders with onset in the first year of life: neurological and cognitive outcome
D Battaglia1, T Randò, F Deodato
1Child Neurology Unit, UCSC, Rome, Italy.
Insights
Prognosis for childhood epilepsy varies by type. Epileptic encephalopathies and symptomatic West syndrome have poor outcomes, while cryptogenic West syndrome and generalized epilepsies with late onset show better results.
Area of Science:
- Pediatric Neurology
- Epileptology
- Developmental Neuroscience
Background:
- Epilepsy in early childhood presents diverse clinical courses.
- Understanding prognostic factors is crucial for effective management and intervention.
Purpose of the Study:
- To classify epilepsy types in infants and evaluate factors influencing neurological and cognitive outcomes.
- To compare prognosis across different epilepsy classifications and etiological subgroups.
Main Methods:
- Prospective examination of 150 children with epilepsy onset in the first year of life.
- Classification into West syndrome, epileptic encephalopathies, generalized, partial, and undetermined epilepsies.
- Evaluation of neurological/cognitive outcomes, etiology, age of onset, family history, and pre-onset psychomotor development.
Main Results:
- Epileptic encephalopathies and symptomatic West syndrome demonstrated poor neurological and cognitive outcomes.
- Cryptogenic West syndrome exhibited a benign prognosis.
- Generalized epilepsies with late onset, cryptogenicity, and no prior cognitive impairment had a good prognosis.
- Partial epilepsies generally showed a poor outcome, regardless of etiology.
Conclusions:
- Epilepsy type and specific clinical features significantly impact long-term neurological and cognitive prognosis in children.
- Early identification of prognostic indicators can guide therapeutic strategies and support for affected children and families.
Abstract:
We examined prospectively a series of 150 children with epilepsy beginning in the first year of life. We classified the types of epilepsy into five categories: West syndrome, other epileptic encephalopathies, generalized, partial and undetermined epilepsies. Of 150 patients, 15 died; 135 were followed for at least 4 years. In order to define possible factors influencing prognosis we evaluated neurological and cognitive outcome and made percentage comparisons between groups, for aetiology, age of onset, family history of epilepsy, and psychomotor development before onset. Epileptic encephalopathies as well as the symptomatic forms of West syndrome showed a very poor neurological and cognitive outcome. As previously recognized, only cryptogenic forms of West syndrome had a benign prognosis. For the generalized epilepsies, analysis of different factors, namely late age at onset, cryptogenicity and absence of primary cognitive impairment, indicated a good prognosis. In contrast, partial epilepsies usually had a poor outcome, irrespective of the aetiology, whether cryptogenic or symptomatic.
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