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Predictors and underlying causes of medically intractable localization-related epilepsy in childhood
Y Ohtsuka1, H Yoshinaga, K Kobayashi
1Department of Child Neurology, Okayama University Medical School, Okayama, Japan.
Insights
Identifying prognostic factors for childhood localization-related epilepsy is crucial. Seizure type, frequency, status epilepticus, and underlying causes significantly predict long-term seizure control in children.
Area of Science:
- Pediatric Neurology
- Epileptology
Background:
- Childhood localization-related epilepsy presents a significant clinical challenge.
- Understanding prognostic factors is essential for optimizing treatment strategies and patient outcomes.
Purpose of the Study:
- To identify and validate predictive factors for seizure control in children with localization-related epilepsy.
- To differentiate between intractable and well-controlled epilepsy cases based on clinical and electroencephalogram (EEG) data.
Main Methods:
- A cohort of 113 children with symptomatic and cryptogenic localization-related epilepsy was analyzed.
- Patients were categorized into intractable (≥1 seizure/month) and well-controlled (no seizures for ≥1 year) groups.
- Clinical data and interictal EEG findings were systematically evaluated.
Main Results:
- Univariate analysis identified seizure type, frequency, cause, age at onset, status epilepticus, and EEG discharges as correlated factors.
- Multivariate analysis confirmed seizure type, frequency, prior status epilepticus, and underlying cause as independent predictors.
- Intractable epilepsy rates were highest in multilobar and frontal-lobe epilepsies, with encephalitis, cortical malformations, and mesial temporal sclerosis being notable etiologies.
Conclusions:
- Seizure type at initial presentation, seizure frequency, history of status epilepticus, and etiology are key independent predictors of long-term seizure outcome in childhood localization-related epilepsy.
- These findings aid in stratifying risk and tailoring management for pediatric epilepsy patients.
Abstract:
The goal of this study is to clarify the prognostic factors in childhood localization-related epilepsy in a tertiary medical center. Children (n = 113) with symptomatic and cryptogenic localization-related epilepsy were divided into groups of intractable patients (average seizure frequency: one or more per month during the 6 months before the last follow-up; n = 40) and well-controlled patients (no seizures for at least 1 year before the last follow-up; n = 73). Clinical and electroencephalogram (EEG) factors were examined to elucidate prognostic factors. The subtypes of epilepsies and causes were also investigated. Univariate analyses indicated that the following factors were correlated with seizure outcome: (1) seizure type at the first visit; (2) seizure frequency; (3) underlying cause; (4) age at onset of epilepsy; (5) status epilepticus occurring as the first seizure and before the first visit; and (6) diffuse epileptic discharges on first visit interictal EEGs. Multivariate analyses revealed that seizure type at the first visit, seizure frequency, status epilepticus before the first visit, and underlying causes were significant independent predictive factors. The rate of intractable patients was highest in multilobar epilepsy, followed by frontal-lobe epilepsy. Regarding etiologies, the intractable group contained nine patients with encephalitis of unknown origin and three each with localized cortical malformation and mesial temporal sclerosis.