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Delayed time to first remission identifies poor long-term drug response of childhood-onset epilepsy: a prospective

Matti Sillanpää1, Dieter Schmidt

  • 1Department of Public Health, University of Turku, Turku, Finland.

Epilepsy & Behavior : E&B
|October 2, 2009
PubMed

Insights

Achieving first 1-year remission (1YR) within five years of starting antiepileptic drugs significantly improves long-term seizure freedom (5-year terminal remission, 5YTR). Delayed remission reduces the likelihood of sustained seizure control.

Area of Science:

  • Pediatric Neurology
  • Epilepsy Research
  • Clinical Pharmacology

Background:

  • Long-term antiepileptic drug (AED) response is crucial for managing childhood epilepsy.
  • Predicting sustained seizure remission remains a challenge in clinical practice.

Purpose of the Study:

  • To determine if the time to achieve first 1-year remission (1YR) predicts future long-term seizure remission (5YTR) in children with epilepsy.
  • To identify prognostic factors for achieving sustained seizure freedom off medication.

Main Methods:

  • A population-based cohort of 144 children with epilepsy was prospectively followed from their first unprovoked seizure.
  • Time to first 1-year remission (1YR) and terminal 5-year remission (5YTR) were assessed.
  • Prognostic factors including etiology and seizure frequency were analyzed.

Main Results:

  • The likelihood of achieving 5YTR was highly dependent on achieving 1YR within the first five years of AED treatment.
  • Patients achieving 1YR within 5 years had an 11-fold increased chance of 5YTR and a 9-fold increased chance of uninterrupted 5YTR off medication.
  • Delayed remission (beyond 5 years) significantly diminished the chances for long-term seizure remission.

Conclusions:

  • Early achievement of 1-year remission is a strong predictor of long-term seizure freedom in children with epilepsy.
  • Failure to achieve remission within five years of AED treatment predicts a poor prognosis for sustained seizure control.
  • Etiology, and seizure frequency before and during treatment, are also important prognostic factors for 5YTR.

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