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Intractable epilepsy in children who develop epilepsy in the first decade of life--a prospective study
J Czochańska1, Z Losiowski, B Langner-Tyszka
1National Research Institute of Mother and Child, Warsaw, Poland.
Insights
This study found that 10% of childhood epilepsy cases are completely resistant to treatment, with factors like early onset and CNS damage contributing. A point-based evaluation system is proposed for predicting treatment failures in pediatric epilepsy.
Area of Science:
- Pediatric Neurology
- Epileptology
- Clinical Research
Background:
- Epilepsy is a common neurological disorder in children.
- Identifying factors contributing to treatment resistance is crucial for effective management.
Purpose of the Study:
- To evaluate the incidence and characteristics of treatment-resistant epilepsy in children.
- To identify predictors of treatment failure in pediatric epilepsy.
Main Methods:
- Prospective study of 347 children with seizures in the first decade of life.
- Analysis of seizure types, etiology, neurological comorbidities, epilepsy syndromes, prior treatments, and socioeconomic factors.
- Patients categorized into four age groups for outcome evaluation.
Main Results:
- 10% of patients exhibited complete resistance to epilepsy treatment; 20% showed partial resistance.
- Key factors for resistance included early childhood onset, symptomatic etiology, central nervous system (CNS) damage, unfavorable syndromes (e.g., Lennox-Gastaut), suboptimal drug selection/dosage, polytherapy, and adverse social conditions.
Conclusions:
- Treatment resistance in pediatric epilepsy is multifactorial.
- A proposed point-based evaluation system may serve as a screening tool to predict treatment failures.
Abstract:
Prospective studies on 347 children under treatment due to seizures which appeared in the first 10 years of life helped to evaluate and define the incidence of epilepsy resistant to treatment. With regard to each patient the following aspects were analysed: the kind of seizures, their etiology, accompanying neurological disorders and a type of epileptic syndrome, kind of treatment applied before admission to the clinical department as well as socioeconomic conditions of the families. Patients under study were divided into four age groups to evaluate the results. Epilepsy, which was completely resistant to treatment, was observed in 10% of the patients, partially resistant in 20%. Resistance is the outcome of the following factors: onset of epilepsy in early childhood, symptomatic etiology coexisting symptoms of CNS damage, occurrence of unfavourable epileptic syndromes such as Lennox-Gastaut, wrong selection and low dosage of drugs, inappropriate polytherapy and adverse social conditions. On the basis of the results obtained, the authors suggested point evaluation as a kind of screening in prediction of failures in treatment.
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