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[Long term remission of epilepsy in childhood: a prospective study]
J Ramos-Lizana1, E Cassinello-García, M Vázquez-López
1Unidad de Neurología Pediátrica, Hospital Torrecárdenas, Almería, 04009, España.
Insights
Over half of children with epilepsy achieve long-term remission off medication. Key factors for sustained remission include epilepsy cause, early seizure control, and diagnosis type.
Area of Science:
- Pediatric Neurology
- Clinical Epilepsy Research
Context:
- Epilepsy affects a significant number of children worldwide.
- Understanding long-term remission is crucial for treatment strategies and quality of life.
Purpose:
- To determine the probability of achieving long-term remission in children diagnosed with epilepsy.
- To identify prognostic factors influencing sustained seizure control and medication discontinuation.
Summary:
- A prospective study followed 90 children under 14 newly diagnosed with epilepsy.
- Kaplan-Meier estimates indicated high probabilities for initial and terminal remission, with over 50% achieving remission off treatment by 5-7 years.
- Cox proportional hazards models identified idiopathic etiology, absence of early seizures, and syndromic diagnosis as predictors of remission.
Impact:
- Findings suggest a favorable prognosis for many children with epilepsy, with a substantial chance of prolonged remission.
- Identifies key predictors that can guide clinical management and patient counseling for epilepsy remission.
Introduction:
To study the chance of achieving a long term remission of epilepsy in children.
Patients And Methods:
90 children aged under 14 years newly diagnosed of epilepsy were started on anticonvulsant treatment and prospectively followed. Initial remission was defined as a seizure free period with or without subsequent recurrences, terminal remission as a seizure free period without subsequent recurrences and terminal remission off treatment as terminal remission plus medication discontinued.
Results:
The Kaplan Meier estimate of the probability of achieving a 3 year initial remission was 80% and 90%, of the probability of achieving a 5 year terminal remission was 59% and 68% and of the probability of achieving a 5 year terminal remission off treatment was 53% and 61% at 5 and 7 years, respectively. Univariate and multivariate analyses using the Cox proportionate hazards model revealed there was a greater probability of achieving a 3 year terminal remission off treatment for patients with idiopathic/cryptogenic etiology and for those who did not have recurrences during the first six months of treatment. Syndromic diagnosis at six months after initiating antiepileptic treatment was also useful for predicting the probability of remission.
Conclusions:
Over half of the epileptic children achieve a prolonged remission off treatment. The main prognostic factors are etiology, recurrence of seizures during the first six months and syndromic diagnosis.