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Risk factors predicting intractability in focal epilepsy in children under 3 years of age: A cohort study
Irawan Mangunatmadja1, Sofyan Ismael1, Sudigdo Sastroasmoro1
1Department of Child Health, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
Insights
Changes in seizure type and EEG rhythm evolution can predict intractable focal epilepsy in young children. Early identification aids treatment guidance for pediatric epilepsy management.
Area of Science:
- Pediatric Neurology
- Epileptology
Background:
- Focal onset epilepsy in children has a higher risk of intractability compared to generalized onset epilepsy.
- Identifying risk factors for intractable epilepsy is crucial for guiding treatment in pediatric focal epilepsy cases.
- Both initial diagnostic factors and the evolution of clinical and electroencephalographic features can predict intractability.
Purpose of the Study:
- To investigate the predictive role of clinical and electroencephalographic (EEG) feature evolution in the intractability of focal epilepsy in young children.
- To identify key factors that may indicate the development of intractable epilepsy in children aged one month to three years.
Main Methods:
- A prospective cohort study involving children aged one month to three years with newly diagnosed focal epilepsy.
- Standardized initial treatment with carbamazepine, with potential addition of valproic acid or phenobarbitone based on response.
- Regular follow-up assessments including clinical evaluation, neurological and developmental status, and electroencephalography (EEG) to track changes and predict intractability.
Main Results:
- Out of 71 subjects, 29.6% exhibited intractable epilepsy by the study's end.
- Age of onset and initial neurological status were not significantly associated with intractable epilepsy.
- Evolution of seizure type (RR 56.45) and background EEG rhythm (RR 56.51) were highly significant predictors of intractable epilepsy (p < 0.001).
Conclusions:
- Changes in seizure type and the evolution of background EEG rhythm are significant predictors of intractable epilepsy in infants and toddlers with focal epilepsy.
- These evolving features can help clinicians anticipate and manage treatment resistance in pediatric focal epilepsy.
- The findings underscore the importance of monitoring clinical and EEG progression for predicting epilepsy intractability in young children.
Background:
Focal onset epilepsy carries a higher risk of intractability than generalized onset epilepsy. Knowledge of the risk factors of intractability will help guide the treatment of children with focal epilepsy. In addition to risk factors present at initial diagnosis, the evolution of clinical and electroencephalographic features may also play a role in predicting intractability.
Methods:
A prospective cohort study was done on children aged one month to three years with newly diagnosed focal epilepsy. Initial treatment of carbamazepine was given according to a standard protocol after assessment of clinical manifestations, neurologic and developmental status, EEG, and brain MRI. Depending on response to therapy, subjects may also receive valproic acid or phenobarbitone following the protocol. Follow-up was done in the second week and every month thereafter. At the end of the study period, seizure type was re-assessed and a repeat neurological and developmental examination and EEG was obtained to evaluate the role of clinical and EEG evolution in predicting intractability.
Results:
Out of 71 subjects, 21 (29.6%) had intractable epilepsy at the end of the study period. Age of onset (p = 0.216) and neurological status (p = 0.052) were not associated with intractable epilepsy. On logistic regression analysis, evolution of seizure type (p < 0.001; RR 56.45; 95%CI 6.56 to 485.85) and evolution of background EEG rhythm (p < 0.001; RR 56.51; 95%CI 2.77 to 1152.16) were significantly associated with intractable epilepsy.
Conclusions:
Changes in seizure type and baseline EEG rhythm may predict intractability in children one month to three years of age with focal epilepsy.
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