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Causes and Risk Factors of Drug-Resistant Epilepsy in Children
Jafar Nasiri1, Mohammadreza Ghazzavi1, Maryam Sedghi2
1Department of Pediatric Neurology, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non- Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.
Insights
Pediatric refractory seizures are linked to birth complications like neonatal asphyxia and early-life seizures. Identifying these risk factors aids in early intervention for drug-resistant epilepsy in children.
Area of Science:
- Neurology
- Pediatric Neurology
- Epileptology
Background:
- Epilepsy is a common chronic neurological disorder globally.
- Refractory seizures affect 20-40% of children with epilepsy, leading to significant impairments.
- Understanding factors contributing to pediatric refractory epilepsy is crucial for effective management.
Purpose of the Study:
- To identify demographic and seizure-associated characteristics of children with refractory seizures.
- To explore potential risk factors for drug-resistant epilepsy in pediatric patients.
Main Methods:
- A cross-sectional study was conducted.
- Children aged 2-16 years with refractory seizures (drug-resistant epilepsy) were assessed.
- Demographic and seizure-associated characteristics were analyzed.
Main Results:
- Children with refractory seizures showed higher rates of neonatal asphyxia, hospitalization post-birth, neonatal seizures, and early-life seizures.
- History of infantile spasms and symptomatic epilepsy were more prevalent.
- Polymorphic seizures and brain MRI abnormalities were significantly more frequent; common etiologies included hypoxic-ischemic damage, cerebral dysgenesis, and genetic disorders.
Conclusions:
- Refractory seizures stem from significant brain structural changes.
- Early identification of risk factors can predict pharmaco-resistant epilepsy.
- This allows for more aggressive treatment and timely specialized interventions.
Objectives:
Epilepsy, the tendency to have recurrent unprovoked seizures, is the most common chronic neurological disorder worldwide. About 20% to 40% of children with epilepsy suffer from refractory seizures, causing neurological, cognitive, and psychosocial impairments. Identifying the factors contributing to pediatric refractory seizures can help neurologists effectively prevent, diagnose, and treat their patients.
Materials & Methods:
In this cross-sectional study, 2 to 16 years old children with refractory seizures (drug-resistant epilepsy) were assessed regarding their demographic and seizure-associated characteristics.
Results:
Children with refractory seizures had a significantly higher rate of neonatal asphyxia, hospitalization after birth, neonatal seizures, and seizure in the first year of life, history of infantile spasm, and symptomatic epilepsy. Furthermore, polymorphic seizures and brain MRI abnormalities were significantly more frequent among them. Several different mechanisms have been suggested for explaining intractability in epileptic patients. None of the mechanisms can explain all patients. The most common underlying etiologies for seizures in the intractable group were hypoxic-ischemic damage, cerebral dysgenesis, and genetic disorders.
Conclusion:
Seizure intractability results from a tremendous deleterious change in the brain's structure. Early identification of the risk factors and prediction of patients likely to have pharmaco-resistant epilepsy will allow more aggressive treatment and earlier specialized intervention.
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