Related Experiment Video
Updated: Aug 25, 2025
Author Spotlight: Advancing Pediatric Epilepsy Surgery in Children Through Novel Biomarkers and Enhanced Localization
Published on: September 20, 2024
Difficult to treat absence seizures in children: A single-center retrospective study
Samo Gregorčič1, Jaka Hrovat1, Neli Bizjak1,2
1Department of Pediatric Neurology, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Insights
Certain absence seizures (AS) are harder to treat in children. Myoclonic AS and AS with eyelid myoclonia, family history, and delayed treatment are linked to difficult to treat absence seizures (DTAS).
Area of Science:
- Pediatric Neurology
- Epileptology
- Clinical Neuroscience
Background:
- Absence seizures (AS) are a common epilepsy syndrome in children, with varying treatment responses.
- Identifying factors associated with difficult to treat absence seizures (DTAS) is crucial for improving patient outcomes.
- Understanding the characteristics of different AS subtypes is essential for targeted therapeutic approaches.
Purpose of the Study:
- To analyze the clinical characteristics of typical AS, myoclonic AS, and AS with eyelid myoclonia in pediatric patients.
- To identify associations between specific AS characteristics and the development of difficult to treat absence seizures (DTAS).
Main Methods:
- A single-center retrospective study reviewed electronic health records of pediatric patients diagnosed with AS.
- Data collected included clinical characteristics, seizure details, anti-seizure medications (ASM), and treatment response over at least a 1-year follow-up.
- DTAS was defined as failure to achieve remission after treatment with at least two ASMs.
Main Results:
- Of 131 patients, 13.7% were classified as DTAS. Remission was achieved in 91.6% of patients during the study period.
- Myoclonic AS and AS with eyelid myoclonia were significantly more likely to be DTAS (40.0%) compared to typical AS (11.4%).
- Factors associated with DTAS included a positive family history of epilepsy, higher pre-treatment seizure frequency, and a longer delay between seizure onset and treatment initiation.
Conclusions:
- Specific clinical features of absence seizures, particularly myoclonic AS and AS with eyelid myoclonia, are associated with a higher likelihood of being difficult to treat.
- Early diagnosis and prompt initiation of anti-seizure medication treatment may improve the prognosis for pediatric patients with absence seizures.
- Further validation in larger, prospective studies is warranted to confirm these findings and refine treatment strategies.
Objectives:
The aim of this study was to analyse the characteristics of typical absence seizures (AS), myoclonic AS and AS with eyelid myoclonia in children and to find associations between these characteristics and difficult to treat absence seizures (DTAS).
Methods:
This was a single-center retrospective study. Electronic health records of pediatric patients with a clinical diagnosis of AS treated at a single tertiary epilepsy center between January 2013 and June 2020 were reviewed. Clinical characteristics, seizure information, ASM, and therapeutic response of patients were recorded. All patients were followed up for at least 1 year. DTAS were defined as failure to achieve remission after treatment with at least 2 anti-seizure medications (ASM), regardless of whether remission was achieved eventually in the study period.
Results:
Data from 131 patients were available for analysis. Remission was achieved after the first ASM treatment in 81 (61.8%) patients, and eventually in 120 (91.6%) during the study period. Epilepsy was classified as DTAS in 18 (13.7%) patients. AS were more often difficult to treat in patients with myoclonic AS and AS with eyelid myoclonia (40.0%), compared with patients with typical AS (11.4%; p = 0.012, 95% CI 1.480-25.732). A positive family history of epilepsy (p = 0.046; 95% CI 1.021-8.572), a higher seizure frequency (p = 0.023, 95% CI 1.009-1.126) prior to ASM treatment, and longer time between seizure onset and treatment onset (p = 0.026; 95% CI 1.006-1.099) were also associated with DTAS.
Significance:
Our study suggests that several clinical characteristics of AS are associated with DTAS. One of these was the time between onset of AS and initiation of ASM treatment, which can be shortened with better care, suggesting that early diagnosis and treatment may improve prognosis in pediatric patients with AS. These findings remain to be confirmed in larger prospective studies.
More Related Videos
10:22Interictal High Frequency Oscillations Detected with Simultaneous Magnetoencephalography and Electroencephalography as Biomarker of Pediatric Epilepsy
Published on: December 6, 2016
06:04Author Spotlight: Studying Clinical Characters and Epilepsy Outcomes After Frontal Disconnection in Patients with MOGHE
Published on: August 16, 2024
Related Concept Videos
01:24Epilepsy and Seizures: Overview
Various factors can trigger epilepsy, including genetic factors, brain damage, metabolic causes, and unknown etiology. Diagnosis of epilepsy involves electroencephalography (EEG), which...
01:13Seizures: Classification
Seizures are typically classified into two main categories: focal and generalized seizures.
Focal Seizures
Focal seizures originate from specific regions of the brain. These seizures are further sub-classified into two types: