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Absence epilepsy: early prognostic signs
1Department of Neurology, Children's Hospital Aghia Sophia, Athens, Greece.
Insights
This study on typical absence epilepsy in children found that sodium valproate and ethosuximide are effective treatments. Relapse factors include poor initial response, EEG abnormalities, photosensitivity, and early antiepileptic drug withdrawal.
Area of Science:
- Pediatric Neurology
- Epileptology
- Clinical Neuroscience
Background:
- Typical absence epilepsy is a common childhood epilepsy syndrome.
- Understanding its clinical presentation, EEG findings, and treatment response is crucial for effective management.
Purpose of the Study:
- To analyze the clinical characteristics, EEG patterns, and treatment outcomes in a cohort of children with typical absence epilepsy.
- To identify factors associated with treatment success and relapse.
Main Methods:
- Retrospective analysis of 124 children diagnosed with typical absence epilepsy.
- Evaluation of demographic data, seizure types, family history, EEG findings (including photosensitivity), and treatment response to antiepileptic drugs (AEDs).
Main Results:
- Absence seizures were the predominant seizure type (82%).
- Sodium valproate and ethosuximide showed high efficacy (85% for absences alone, 68% for absences with GTCS).
- Factors predicting relapse included poor initial response, focal EEG abnormalities, marked photosensitivity, evolution to myoclonic epilepsy, and early AED withdrawal (<3 years).
Conclusions:
- Typical absence epilepsy in children presents with varied onset ages and seizure combinations.
- Monotherapy with sodium valproate or ethosuximide is highly effective for most patients.
- Identifying relapse predictors is essential for long-term management and preventing recurrence.
Abstract:
We have studied 124 children with typical absence epilepsy. The onset of symptoms was in 12% under 4 years, in 51% between 4-8 years and in 37% above 8 years. The F:M ratio was 2:1 in children under 4 years versus 1:1 above 8 years. Absences alone occurred in 82% and absences followed or preceded by generalized tonic-clonic seizures (GTCS) in 6.5% and 11%, respectively. Simple absences were not seen in children under 4 years and were more frequent (14%) in the 4-8 years age group. Family history was positive for epilepsy in 20% and febrile convulsion in 7%. Sixteen percent had a positive past history of febrile convulsions. All patients showed bilateral, synchronous spike-wave discharges from 2.5 to 4 c/s. Lateralized spikes, spike-slow wave complexes were found in 27%. Photosensitivity was present in 18% and was marked in 12%. Monotherapy with sodium valproate or ethosuximide (91% SV) was successful in 85% of patients with absences alone and 68% of the absences with GTCS. Only 2% were not fully controlled either on monotherapy or polytherapy. Treatment was withdrawn in 41 patients and 13 relapsed. We have identified four factors associated with relapses: (a) poor initial response to treatment, (b) lateralized focal EEG abnormality and/or marked photosensitivity, (c) the evolution to myoclonic epilepsy, and (d) early withdrawal of AED (< 3 years).