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Pattern and etiology of early childhood epilepsy: An Experience at a tertiary care University Center
Amal Y Kentab1, Shumukh Al Bulayhi1, Muddathir H Hamad1
1From the Division of Pediatric Neurology (Kentab, Al Bulayhi, Hamad, Al Wadei, Bashiri), Department of Pediatrics, King Khalid University Hospital, King Saud University Medical City, and from the Department of Pediatrics (Kentab, Bashiri), College of Medicine, King Saud University, and from the Department of Pediatric Neurology (Al Wadei), National Neuroscience Institute, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia.
Insights
Epilepsy in young children often has unknown causes, with genetic and structural factors being the most common identified etiologies. This study analyzed seizure types and causes in infants under two years old.
Area of Science:
- Pediatric Neurology
- Epileptology
- Clinical Neuroscience
Background:
- Epilepsy in infants and toddlers presents unique diagnostic challenges.
- Understanding the etiology and seizure characteristics is crucial for effective management in early life.
Purpose of the Study:
- To classify epilepsy types and determine the causes in children aged two years or younger.
- To apply the 2017 International League Against Epilepsy (ILAE) classification criteria.
Main Methods:
- Retrospective chart review of 150 children diagnosed with epilepsy and on anti-seizure medications.
- Data collection included seizure details, electroclinical findings, neuroimaging, and laboratory evaluations.
- Analysis of etiology based on the 2017 ILAE classification.
Main Results:
- The etiology remained unknown in 31.3% of cases, followed by genetic (28.7%) and structural (27.3%) causes.
- Generalized epilepsy was most common, including generalized tonic-clonic seizures (37%) and tonic seizures (21%).
- Abnormalities in neurological examination and neuroimaging were more frequent in genetic and structural epilepsy groups.
Conclusions:
- A significant proportion of early-life epilepsy cases have undetermined etiologies.
- Genetic and structural causes are the leading identified factors in this pediatric cohort.
- Findings contribute to the global understanding of epilepsy in the first two years of life.
Objectives:
To investigate seizure characteristics, types, and define the etiology of epilepsy in children aged ≤2 years using the 2017 ILAE classification.
Methods:
A retrospective chart review was conducted at King Khalid University Hospital, King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia for children below 2 years of age diagnosed with epilepsy, and on anti-seizure medications from January 2017 - December 2018. The collected data involved detailed information on the patients' seizure, electroclinical, neuroimaging, laboratory evaluations, and underlying etiology.
Results:
One- hundred and fifty patients were included in the study and classified according to etiology into: genetic (43, 28.7%), structural (41, 27.3%), metabolic (10, 6.7%), infectious (8, 5.3%), immune-mediated (1, 0.7%) and unknown (47, 31.3%) groups. The most common seizure types were generalized epilepsy, among which generalized tonic-clonic seizures occurred in 56 (37%) patients, followed by tonic seizures in 31 (21%), infantile spasm in 19 (13%), myoclonic seizures in 4 (2.7%), atonic seizures in 6 (4%), and focal seizures in 33 (22%) patients. Global developmental delay and abnormalities in both neurologic exam and neuroimaging were more common in the structural and genetic groups. Electroencephalography was abnormal in 82 (55%) patients, including the majority of the structural group (26, 63.4%).
Conclusion:
The etiology of epilepsy in this cohort remains undetermined (unknown) in a large proportion of cases, followed by genetic and structural causes. This result added to the published international data about epilepsy in the first 2-years of life.
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