Related Experiment Videos
Difficult to control epilepsy in childhood--a long term study of 123 cases
V P Udani1, V Dharnidharka, A Nair
1Department of Child Neurology, P.D. Hinduja National Hospital and Medical Research Centre, Bombay.
Insights
Difficult to control epilepsy (DCE) in children often stems from early onset, intellectual disability, and specific seizure types. EEG proved more valuable than neuroimaging for diagnosis, with many patients responding well to optimized monotherapy.
Area of Science:
- Pediatric Neurology
- Epileptology
- Clinical Neuroscience
Background:
- Difficult to control epilepsy (DCE) presents significant challenges in pediatric populations.
- Understanding etiological factors and treatment responses is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate the etiological factors, diagnostic utility of investigations, and treatment outcomes in children with difficult to control epilepsy.
- To identify risk factors and predictors of treatment response in pediatric DCE.
Main Methods:
- Retrospective study of 123 children diagnosed with difficult to control epilepsy.
- Analysis of etiological factors, seizure types, neurological status, EEG, neuroimaging (CT/MRI), prior therapies, and treatment responses.
- Evaluation of treatment strategies including monotherapy, dosage adjustments, and anticonvulsant selection.
Main Results:
- Predominant factors included early age of onset (<2 years), male sex, mixed/generalized/partial seizures, mental retardation, and neurological abnormalities.
- Electroencephalography (EEG) was abnormal in 84% and correlated with seizure type in 81%; CT/MRI had limited diagnostic and therapeutic utility.
- A good treatment response (≥50% seizure reduction) was observed in 67% of patients, particularly those with normal intellect on optimized monotherapy; mortality was 4%.
Conclusions:
- Early onset, mental retardation, and specific seizure types are significant risk factors for difficult to control epilepsy in children.
- EEG is a more valuable diagnostic tool than neuroimaging in this population.
- Optimized monotherapy, including supranormal dosages and avoidance of sedating anticonvulsants, can lead to favorable treatment responses in pediatric DCE.
Abstract:
One hundred and twenty three children with difficult to control epilepsy (DCE) were studied. Etiological factors which predominated included an age of onset less than 2 years (71.5%), male sex (69%), mixed, secondarily generalized, or complex partial seizures (77%), mental retardation (64%) and neurological abnormalities (52%). Static neurological disease was seen in 63%, with only 17% having idiopathic disease. Identifiable epileptic syndromes were noted in less than half the children. The surface EEG was abnormal in 84%, and correlated with the clinical seizure type in 81%. CT and MRI were helpful in diagnosis in only 38 and 48%, respectively, and even less so in therapy decisions, 7 and 16%, respectively. Prior therapy revealed the use of polytherapy in 61% and suboptimal dosages in 78%. In the 100 patients with adequate follow up, 67% showed a good response, i.e., 35% complete and 32% more than 50% reduction in seizures. Only 11% were total nonresponders, and most were severely retarded. Major treatment strategies employed included switching to monotherapy, supranormal dosages and avoidance of sedative anticonvulsants. Side effects were noted in 41% with 8 cases being life threatening. Overall mortality was 4%. We concluded that risk factors for DCE included early age of onset, mental retardation and certain seizure types. EEG was more helpful than neuroimaging. Treatment responses were favorable, especially in those with normal intellect and the use of normal or high dose monotherapy.