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Prevalence, classification, and severity of epilepsy in children in western Norway
P E Waaler1, B H Blom, H Skeidsvoll
1Department of Pediatrics, Haukeland University Hospital, Bergen, Norway.
Insights
The prevalence of active epilepsy in school children is 5.1 per 1,000, with most cases classifiable. Symptomatic causes are common, particularly in therapy-resistant epilepsy, highlighting the need for multidisciplinary care.
Area of Science:
- Neurology
- Pediatrics
- Epileptology
Background:
- Childhood epilepsy presents diagnostic and therapeutic challenges.
- Accurate classification of epilepsy is crucial for effective management.
- Understanding prevalence and etiology informs public health strategies.
Purpose of the Study:
- Determine the prevalence of active epilepsy in school-aged children.
- Evaluate the utility of International League Against Epilepsy (ILAE) classifications.
- Identify challenges in severe childhood epilepsy cases, including handicaps and treatment.
Main Methods:
- Utilized ILAE classifications (ICES, 1981; ICE, 1989) for seizure and syndrome categorization.
- Conducted neuropediatric, EEG, and intelligence evaluations for 6-12 year olds in a Norwegian county.
- Performed additional investigations as necessary.
Main Results:
- Prevalence of active epilepsy was 5.1 per 1,000 children.
- 98% of seizure types and 90% of epilepsy syndromes were classifiable.
- Partial/localization-related epilepsies were more common than generalized forms.
- Symptomatic etiology was identified in 46% of children, rising to 81% in therapy-resistant cases.
- 25% of children were not on current antiepileptic drug (AED) treatment; 26% had tried 3-15 AEDs.
Conclusions:
- Most childhood epilepsies are classifiable, though non-specific categories remain.
- Symptomatic etiology is a significant factor, especially in difficult-to-treat epilepsy.
- Multidisciplinary approaches are essential for comprehensive management of childhood epilepsy.
Purpose:
To determine prevalence of active epilepsy in school children in a defined area and assess the usefulness of International League Against Epilepsy classification of seizures and epileptic syndromes, with special emphasis on frequency, additional handicaps, and therapeutic problems of severe cases.
Methods:
The latest International League Against Epilepsy International Classification of Epileptic Seizures (ICES, 1981) and Epilepsies and Epileptic Syndromes (ICE, 1989) were used for determination of prevalence rates, seizure types, epilepsies and epileptic syndromes, and additional neurological deficits in all 6-to 12-year-old children with epilepsy in a Norwegian county. Children had neuropediatric and EEG examination, intelligence evaluation, and, when necessary, additional investigations.
Results:
Prevalence of active epilepsy on January 1, 1995, was 5.1 per 1,000. Main seizure type and epilepsy syndrome could be classified in 98% and 90% of patients, respectively. Seizure types/epileptic syndromes were more often partial/localization related than generalized. Among generalized epilepsies, idiopathic forms were more frequent in girls, and cryptogenic and symptomatic forms more frequent in boys. Epileptogenic EEG activity was most often generalized or localized to one or two areas of the brain and was never found in 14% of patients. Symptomatic etiology was found in 46% of all children and in 81% of therapy-resistant cases, respectively. Over the years, 11% of children had never used antiepileptic drugs (AED), 62% had tried one or two AEDs, and 26% had tried from three to 15 AEDs. Twenty-five percent of children were without present AED treatment. Complementary/alternative medicine had been tried by 12% of children.
Conclusions:
Although most epilepsies could be classified, the number of cases in non-specific categories was relatively high. Symptomatic etiology was frequent, especially in therapy-resistant cases. Multidisciplinary therapeutic and habilitation approaches are often needed in childhood epilepsy.