The purpose of the follow-up study was to determine whether modern therapy with ethosuximide and/or valproate with/without phenobarbitone and its derivatives improves the longterm prognosis of absence epilepsy as compared to formerly used treatments. The patient population consisted of 194 cases (88 boys, 106 girls) with spike wave epilepsy starting with absences. In each case the diagnosis was confirmed by clinical observation and the typical EEG pattern. Only those patients were included who could be followed beyond the eighteenth year of life (up to age 45). The sample includes also older patients diagnosed during the fifties, before the present standard therapy was available. Because of the heterogeneity of the material and its selection, the data obtained are not suited to make a general statement about the ultimate prognosis of absences. The results demonstrate the effectiveness of regularly applied modern treatment. 72 out of 194 patients (37%) manifested generalized tonic clonic seizures (gtcs) during the course: 20 of these patients showed only incidental generalized tonic clonic seizures, which were not dependent on therapy. In 52 cases gtcs appeared without relation to precipitating factors. None of these patients received regular standard therapy before onset of gtcs. In 31 cases absence statuses were observed. These patients did not have an unfavourable outcome provided the standard therapy was instituted early and consequently. A change from absence epilepsy into an epilepsy with complex partial seizures sensu strictiori could not be observed. At final investigation 42 of 194 patients still had seizures: 7 with absences, 35 with grand mal with or without absences.(ABSTRACT TRUNCATED AT 250 WORDS)
Children of epileptic mothers have a higher risk for major malformations. A similar increase of major malformations is observed in children of epileptic fathers suggesting that the major malformations are related to the parental disease rather than to the antiepileptic drug. No information was available if the pattern of minor acrofacial malformations known as the "hydantoin syndrome" occurs also in children of epileptic fathers. We studied 37 children of treated mothers and 22 children of treated fathers with epilepsy. No major malformations were observed. The typical acrofacial syndrome occurred only in children of epileptic mothers suggesting that this characteristic syndrome is drug-related. Major malformations and the syndrome of minor acrofacial anomalies seem to have a different etiology. Since the pattern of minor acrofacial anomalies occurs after exposure to anticonvulsants other than hydantoin the term "antiepileptica syndrome" should be used for this particular embryopathy.
One boy, given radiotherapy and cytostatic drugs for a rhabdomyosarcoma died nine years later of acute leukaemia. A girl, who had received radiotherapy for an inoperable suprasellar tumour and also given cytostatic drugs, fell ill seven years later with a glioblastoma. Among a total of 750 children with malignant neoplasm observed by the authors, a permanent cure rate of about 50% is to be expected among about 300 children treated recently. If this rate applies to the entire Federal Republic of Germany, about 1,000 children are likely to be cured annually. In these circumstances it is likely that 80-160 children treated in any one year will develop a second neoplasm or leukaemia 20 years later, most commonly as a late sequela of the treatment.
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