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Complex partial seizures of childhood onset. A five-year follow-up study
P Kotagal1, A D Rothner, G Erenberg
1Section of Pediatric Neurology, Cleveland Clinic Foundation, OH 44106.
Insights
Complex partial seizures (CPS) in children are challenging to manage, with many experiencing ongoing difficulties. Epilepsy surgery can improve seizure control and long-term outcomes for selected patients.
Area of Science:
- Pediatric Neurology
- Epileptology
- Clinical Neuroscience
Background:
- Limited long-term outcome data exists for childhood-onset complex partial seizures (CPS).
- Previous research often included heterogeneous patient groups, confounding results.
- Defining CPS rigorously is crucial for understanding prognosis.
Purpose of the Study:
- To evaluate the long-term prognosis of children and adolescents with clinically and electroencephalographically defined CPS.
- To assess the impact of epilepsy surgery on seizure control and functional outcomes.
- To identify factors influencing seizure remission and long-term quality of life.
Main Methods:
- Longitudinal follow-up of 29 pediatric patients with confirmed CPS for at least five years.
- Detailed clinical assessment, electroencephalography (EEG), and evaluation of treatment outcomes.
- Analysis of seizure status, medication use, and associated educational, behavioral, and vocational outcomes.
Main Results:
- Twelve patients achieved seizure freedom, with eight undergoing epilepsy surgery.
- Eight patients had intractable seizures despite management.
- No spontaneous remission occurred without anticonvulsant medication; only one patient discontinued therapy post-surgery.
- Half the cohort experienced significant school difficulties, behavioral problems, or unemployment.
Conclusions:
- Childhood-onset CPS are often difficult to control and require aggressive management strategies.
- Epilepsy surgery offers a viable option for seizure control in selected pediatric patients.
- Successful surgery can improve educational, social, and vocational potential, alongside seizure freedom.
Abstract:
Few detailed studies have examined the long-term outcome of complex partial seizures (CPS) in children and adolescents. Previous studies have selected patients on clinical criteria only or have included those with benign focal epileptiform discharges of childhood, nonepileptiform sharp transients, and generalized epileptiform discharges. We have followed up 29 patients with clinically and electroencephalographically defined CPS of childhood onset for five years or more. Twelve patients are seizure free, eight of them after having epilepsy surgery. Of the remaining, eight patients have intractable seizures. Only one patient was able to discontinue anticonvulsant therapy after epilepsy surgery. No patient had spontaneous remission of seizures without anticonvulsant medications. School difficulties, behavior problems, and unemployment were seen in half the group. We believe CPS in this age group are difficult to control and need aggressive management. In selected patients, epilepsy surgery offers a good chance of seizure control and improvement of educational, social, and vocational potential.