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Epilepsy in childhood: an audit of clinical practice
H A Carpay1, W F Arts, A T Geerts
1Department of Child Neurology, Westeinde Hospital, The Hague, The Netherlands.
Insights
Many children with new-onset epilepsy may not require antiepileptic drugs (AEDs). Treatment outcomes for pediatric epilepsy can vary, with some achieving seizure control without remission.
Area of Science:
- Pediatric Neurology
- Epileptology
- Clinical Therapeutics
Background:
- Uncertainty exists regarding the necessity of antiepileptic drugs (AEDs) for children with epilepsy.
- The efficacy of sequential AED treatment regimens and the achievement of acceptable seizure control without complete remission are not well-defined.
Purpose of the Study:
- To investigate treatment strategies and outcomes in a cohort of children with epilepsy.
- To determine the proportion of children who may not require AEDs and to assess seizure control in those undergoing treatment.
Main Methods:
- A prospective, multicenter, hospital-based study followed 494 children with diverse epilepsy types for at least 2 years.
- No standardized treatment protocol was used; neurologists determined individual treatment strategies.
- Outcomes were evaluated based on seizure remission and overall seizure control.
Main Results:
- Initial treatment with AEDs was withheld in 29% of children; 17% remained untreated after 2 years without complications.
- Among treated children, 60% used their first AED for 2 years, with 80% on monotherapy.
- Intractable epilepsy (failure to achieve acceptable control) was diagnosed in only 7% of the 494 children.
Conclusions:
- A significant proportion of children with new-onset epilepsy do not necessitate AED treatment.
- Treatment success rates decreased with successive AED regimens.
- Some children with recurrent seizures achieved acceptable seizure control, indicating they did not have intractable epilepsy.
Background:
It is not known how many children with epilepsy may not need treatment with antiepileptic drugs (AEDs), how many respond unsatisfactorily to subsequent treatment regimens, and how many achieve "acceptable control" despite lack of remission.
Methods:
In a prospective multicenter hospital-based study, 494 children with a broad range of seizure types and types of epilepsy were followed up for at least 2 years. There was no standard treatment protocol. We describe the treatment strategies applied to these children by the neurologists in charge and outcome with respect to remission from seizures.
Results:
Treatment was initially withheld in 29% of the children, and after 2 years 17% still had not received any AEDs. There were no serious complications caused by withholding treatment. Of the children treated with AEDs, 60% were still using the first AED after 2 years; 80% received monotherapy and 20%, polytherapy. Children with severe symptomatic epilepsies, such as the West or Lennox-Gastaut syndrome, received polytherapy early on in the course of treatment. When 3 regimens had failed, the chance of achieving a remission of more than 1 year with subsequent regimens was 10%. Nevertheless, 15 of 50 children receiving AEDs in whom the "longest remission ever" was less than 6 months did achieve acceptable seizure control according to the neurologist in charge of treatment. Hence, of 494 children, only 35 (7%) developed an intractable form of epilepsy, defined as failure to bring seizures under acceptable control.
Conclusions:
A substantial percentage of children with new-onset epilepsy did not need treatment with AEDs. Chances of achieving a good outcome declined with subsequent treatment regimens. Not all children with recurrent seizures were suffering from intractable epilepsy; some had achieved acceptable control of seizures.