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Outcome of childhood epilepsy: a population-based study with a simple predictive scoring system for those treated
C Camfield1, P Camfield, K Gordon
1Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.
Insights
Approximately 55% of childhood epilepsy cases remit. A new scoring system accurately predicts remission based on factors like age at onset and seizure history, aiding in medication discontinuation decisions.
Area of Science:
- Neurology
- Pediatrics
- Epidemiology
Background:
- Childhood epilepsy remission rates vary.
- Predicting remission is crucial for treatment management.
- Accurate prediction aids in medication discontinuation.
Purpose of the Study:
- To predict which children with epilepsy are likely to achieve remission.
- To develop a scoring system for epilepsy remission prediction.
- To estimate the duration of medication treatment for remitted cases.
Main Methods:
- Population-based study in Nova Scotia (1977-1985).
- Identified children with epilepsy onset (excluding absence and minor motor seizures).
- Multivariate analysis and survival curve methods used for prediction and duration estimation.
Main Results:
- 55% of the total cohort achieved remission (off medication).
- Predictors of remission at diagnosis: age < 12, normal intelligence, no neonatal seizures, < 21 pre-treatment seizures.
- Scoring system predicted 80% remission by 100 months post-diagnosis.
Conclusions:
- Approximately 55% of childhood epilepsy cases remit.
- A developed scoring system accurately predicts remission and medication discontinuation timing.
- Prediction accuracy improved with seizure data during treatment.
Abstract:
A population-based study was conducted in an attempt to predict which child's epilepsy will remit. Use of data from a regional electroencephalography laboratory allowed identification of all children in Nova Scotia with epilepsy onset from 1977 through 1985 (excluding those with absence and "minor motor" seizures). Children were followed for an average of 7 years. On the basis of clinical characteristics, a multivariate analysis was used to develop a scoring scheme to predict remission (defined as off medication at the end of the follow-up period). Survival curve methods were used to estimate the duration of medication treatment for those with remission. Of the 504 eligible patients, approximately 70% became seizure free long enough to discontinue medication. Approximately 70% of those stopping medication a first time remained seizure free. At the end of follow-up, 55% of the total cohort were in remission. At diagnosis, the best predictors of remission were age < 12 years at onset, normal intelligence, no prior neonatal seizures, and fewer than 21 seizures before treatment. If predicted to have a remission, then, on the basis of survival curve analysis, 80% were without medication 100 months after diagnosis. After 12 months of treatment, prediction was enhanced by including a score for the number of seizures between 6 and 12 months on treatment. We conclude that approximately 55% of childhood epilepsy will remit. Our scoring system predicts reasonably accurately who will have a remission and when medication is likely to be discontinued.