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Early development of intractable epilepsy in children: a prospective study
A T Berg1, S Shinnar, S R Levy
1Northern Illinois University, Department of Biological Sciences, DeKalb, IL 60115, USA. atberg@niu.edu
Insights
Early prediction of intractable epilepsy (IE) in children is crucial. Approximately 10% of children develop IE, with higher risks in generalized syndromes and initial frequent seizures.
Area of Science:
- Pediatric Neurology
- Epileptology
Background:
- Limited understanding of early predictors for intractable epilepsy (IE) in children.
- Early prediction can guide timely therapeutic interventions for selected pediatric epilepsy patients.
Purpose of the Study:
- To identify early predictors of intractable epilepsy (IE) in children with newly diagnosed epilepsy.
- To inform early treatment strategies for pediatric epilepsy.
Main Methods:
- Prospective cohort study of 613 children with newly diagnosed epilepsy.
- Follow-up for occurrence of IE defined by treatment resistance and seizure frequency.
- Classification of epilepsy syndromes and etiological factors according to International League Against Epilepsy guidelines.
Main Results:
- Approximately 10% of children met criteria for IE.
- Cryptogenic/symptomatic generalized epilepsy syndromes showed the highest IE risk.
- Higher initial seizure frequency and focal EEG slowing were associated with increased IE risk.
- Age at onset between 5-9 years was linked to a reduced IE risk.
Conclusions:
- About 10% of pediatric epilepsy cases progress to intractable epilepsy (IE).
- Specific epilepsy syndromes (cryptogenic/symptomatic generalized) and initial seizure frequency are key predictors of IE.
- Early identification of risk factors is essential for managing pediatric intractable epilepsy.
Background:
Little is known about early prediction of intractable epilepsy (IE) in children. Such information could help guide the early use of new therapies in selected patients.
Methods:
Children with newly diagnosed epilepsy (n = 613) were prospectively identified from child neurology practices in Connecticut (1993--1997) and followed-up for the occurrence of IE (failure of > or = 2 drugs, > or = 1 seizure/month, over 18 months) [corrected]. Etiology and epilepsy syndromes were classified per International League Against Epilepsy guidelines.
Results:
The median follow-up is 4.8 years, and 599 (97.7%) have been followed for more than 18 months. Sixty children (10.0%) have met the criteria for IE, including 34.6% with cryptogenic/symptomatic generalized, 2.7% with idiopathic, 10.7% with other localization-related, and 8.2% with unclassified epilepsy (p < 0.0001). After multivariable adjustment for epilepsy syndrome, initial seizure frequency (p < 0.0001), focal EEG slowing (p = 0.02), and acute symptomatic or neonatal status epilepticus (p = 0.001) were associated with an increased risk of IE, and age at onset between 5 and 9 years was associated with a lowered risk (p = 0.03). The absolute number of seizures and unprovoked or febrile status epilepticus were not associated substantially with IE.
Conclusions:
Approximately 10% of children meet criteria for IE early in the course of their epilepsy. Cryptogenic/symptomatic generalized syndromes carry the highest risk and idiopathic syndromes the lowest. Half of IE occurs in children with nonidiopathic localization-related syndromes. Initial seizure frequency is highly predictive of IE. By contrast, absolute number of seizures and unprovoked or febrile status epilepticus are not.