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Probability of Remission of the Main Epileptic Syndromes in Childhood
Julio Ramos-Lizana1, Gema Martínez-Espinosa1, Patricia Aguilera-López1
116815Torrecárdenas Hospital, Almería, Spain.
Insights
Most childhood epilepsy syndromes have a high probability of long-term remission without medication. Even children without a specific epilepsy diagnosis often achieve remission, except for those with neurological deficits.
Area of Science:
- Neurology
- Pediatrics
- Epileptology
Background:
- Epilepsy is a common neurological disorder in children.
- Long-term remission rates without antiepileptic drug (AED) treatment are crucial for understanding epilepsy prognosis.
- Variability in remission exists across different epilepsy syndromes and in children without specific diagnoses.
Purpose of the Study:
- To determine the long-term probability of remission without AEDs for common childhood epilepsy syndromes.
- To assess remission rates in children lacking a specific syndromic epilepsy diagnosis.
Main Methods:
- A cohort of 680 children under 14 with unprovoked seizures were prospectively followed.
- Syndromic diagnoses were made retrospectively, blinded to clinical outcomes.
- Kaplan-Meier estimates were used to calculate the probability of a 5-year remission period by age 14.
Main Results:
- High remission probabilities (≥80%) were observed for several syndromes, including well-defined/uncertain childhood epilepsy with centrotemporal spikes, well-defined/uncertain Panayiotopoulos syndrome, and absence epilepsy.
- Excellent remission rates (93-100%) were found for familial and nonfamilial self-limited infantile epilepsy.
- Lower remission rates were noted for juvenile myoclonic epilepsy (6%), symptomatic West syndrome (65%), and cryptogenic West syndrome (71%).
- Children without specific diagnoses showed variable remission: 72% with no neurological deficits, but only 40% with associated deficits.
Conclusions:
- The study provides long-term remission probabilities for key childhood epilepsy syndromes and for children without specific diagnoses.
- Most common childhood epilepsy syndromes demonstrate a favorable long-term prognosis for remission without antiepileptic treatment.
- Prognosis varies significantly based on the specific epilepsy syndrome and the presence of neurological deficits in undiagnosed cases.
Aim:
To determine the long-term probability of remission without antiepileptic treatment of common epileptic syndromes and of children without a specific syndromic diagnosis.
Patients And Methods:
All children less than 14 years old with 2 or more unprovoked seizures seen at our hospital between June 1, 1994, and March 1, 2011 (n = 680), were included and prospectively followed up until August 15, 2020. Syndromic diagnosis was made retrospectively but blinded to subsequent evolution, employing the data available at 6 months after diagnosis and under predefined operational criteria.
Results:
The Kaplan-Meier estimate of the probability of achieving a remission period of at least 5 years, with neither seizures nor antiepileptic treatment at 14 years was 97% for well-defined childhood epilepsy with centrotemporal spikes, 82% for uncertain childhood epilepsy with centrotemporal spikes, 85% for well-defined Panayiotopoulos syndrome, 88% for uncertain Panayiotopoulos syndrome, 93% for nonfamilial self-limited infantile epilepsy, 100% for familial self-limited infantile epilepsy, 86% for absence epilepsy, 6% for juvenile myoclonic epilepsy, 71% for cryptogenic West syndrome, 72% for patients with no associated neurologic deficits and no specific syndromic diagnosis, 65% for symptomatic West syndrome, and 40% for patients with associated neurologic deficits and no specific syndromic diagnosis.
Conclusions:
The study results highlight the long-term outcomes of the main epileptic syndromes and also of the patients with no syndromic diagnosis.
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