Factors influencing pediatric epilepsy outcomes: Predictive variables and adherence to clinical practice guidelines

Pediatric epilepsy constitutes significant challenges for long-term management in resource-limited settings. This study determined factors influencing epilepsy outcomes in children (predictive variables) and assessed adherence to clinical practice guidelines (CPG) and its effect on clinical outcomes, addressing the evidence gap in Indian settings.

We enrolled prospectively followed 170 children (<18 years) diagnosed with epilepsy, treated and monitored at a tertiary-care university hospital from 'January 2021 to December 2024'. Adherence to clinical practice guidelines (CPG) was assessed using 'Indian Academy of Pediatrics' and 'American Epilepsy Society' standards. Clinical outcomes were studied and classified as 'favorable (seizure freedom)' and 'unfavorable (seizure recurrence at 6 months of ASM initiation AND/OR active epilepsy ≥1 year of ASM initiation AND/OR time to seizure freedom exceeding 15 months after ASM initiation)'. Factors predictive of unfavorable epilepsy outcomes were analyzed using multivariate regression, and the event probabilities were estimated using Kaplan-Meier analysis.

Of 170 children, 117 (68.8 %) diagnosed with new‑onset epilepsy (NOE) and 53 (31.2 %) with drug‑resistant epilepsy (DRE). The median (IQR) age was 4.6 (3.1 - 11.5) years. Male preponderance was observed [93 (54.7 %)]. Overall adherence to CPG was 70 %, with deviations noted in 28.2 % of NOE cases and in 34 % of DRE cases. Seizure recurrence at 6 months of ASM initiation [82.4 % versus 64.7 %, P = 0.034] and active epilepsy for ≥ 1 year of ASM initiation [60.8 % versus 32.8 %, P = 0.001] was higher in CPG non-adherent group. Seizure freedom was observed in a total of 100 (58.8 %) children. Patients from CPG non-adherent group took longer (>15 months) to gain seizure freedom (P < 0.042). Of 11 studied factors predictive of unfavorable epilepsy outcomes, 2 factors in NOE and 5 factors in DRE achieved statistical significance. Kaplan-Meier analysis demonstrated increased hazards of unfavorable epilepsy outcomes in patients with DRE compared to NOE, (HR 2.3, 95 % CI 1.2-4.7, P = 0.0147).

Adherence to CPG was associated with favorable epilepsy outcomes, while non‑adherence predicted higher risk of seizure recurrence and prolonged active epilepsy. DRE cases demonstrated significantly greater risk of unfavorable epilepsy outcomes compared to NOE, underscoring the importance of guideline‑based management in optimizing pediatric epilepsy care.