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Etiology and clinical predictors of intractable epilepsy
Sanjay Chawla1, Satinder Aneja, Ravi Kashyap
1Department of Pediatrics, Kalawati Saran Children's Hospital, New Delhi, India.
Insights
Intractable epilepsy in children is often caused by perinatal issues or CNS infections. Neurologic impairment and early seizure onset are key predictors of this challenging condition.
Area of Science:
- Neurology
- Pediatrics
- Epileptology
Background:
- Intractable epilepsy presents a significant challenge in pediatric care.
- Identifying etiological factors and clinical predictors is crucial for effective management.
Purpose of the Study:
- To investigate the causes of intractable epilepsy in children.
- To identify clinical predictors associated with intractable epilepsy.
Main Methods:
- A case-control study involving 50 children with intractable epilepsy and 50 controls.
- Evaluation included birth history, development, clinical examination, and neurodevelopmental assessment.
- Drug monitoring was used to rule out pseudointractability.
Main Results:
- Perinatal problems (48%) and CNS infection sequelae (24%) were primary causes of intractable epilepsy.
- Idiopathic epilepsy was more common in controls (72%) than in the study group (20%).
- Independent predictors of intractable epilepsy included neurologic impairment, early seizure onset (<1 year), myoclonic seizures/infantile spasms, and remote symptomatic epilepsy.
Conclusions:
- Neurologic impairment, early seizure onset, specific seizure types, and remote symptomatic epilepsy are significant predictors of intractable epilepsy in children.
- Etiology differs significantly between intractable and controlled epilepsy cases.
Abstract:
To determine the etiology and clinical predictors of intractable epilepsy, a case-control study comprising 50 patients and 50 control subjects was performed. Patients included children who had more than one seizure per month over at least 6 months. Control subjects included children with epilepsy who had been seizure-free for more than 6 months. Patients were evaluated with special reference to birth history and development. Clinical examination and neurodevelopmental assessment were performed in all the patients. Drug monitoring was performed to exclude pseudointractability. Epilepsy in the study group was caused by perinatal problems (48%) and sequelae of central nervous system infection (24%) and was idiopathic in 20%. In the control group, epilepsy was idiopathic in 72%, a result of calcified granuloma in 22%, and perinatal problems comprised 6% of the subjects. On univariate analysis, strong association was evident between intractable epilepsy and several factors, including age at onset of seizure, remote symptomatic epilepsy, initial seizure type, history of neonatal seizure, high initial seizure frequency, microcephaly, and neurologic impairment. On multivariate analysis, neurologic impairment (odds ratio [OR] 12.25; 95% confidence interval [CI] 3.58-41.89), age at onset of seizure less than 1 year (OR 11.70; 95% CI 2.95-46.43), myoclonic seizure/infantile spasm (OR 10.36; 95% CI 2.39-44.93), and remote symptomatic epilepsy (OR 2.9; 95% CI 1.13-7.43), were independent predictors of intractability.