Absence epilepsy: early prognostic signs

Covanis, Athanasios; Skiadas, Konstantinos; Loli, Nomiki; Lada, Christina Olly; Theodorou, Virginia

doi:10.1016/1059-1311(92)90038-3

Cited by 49 publications

(43 citation statements)

References 26 publications

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“…In their study of 124 children with typical absence epilepsy, Covanis et al (6) noted that monotherapy with either VPA or ESM was successful in 85% of children with absence seizures alone, and in 68% of those with coexisting generalized tonic–clonic seizures. In most cases, VPA rather than ESM was preferentially used as first‐line therapy.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Significance of Failure of the Initial Antiepileptic Drug in Children with Absence Epilepsy

Wirrell

Camfield

et al. 2001

Epilepsia

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Summary:Purpose: In children with childhood absence epilepsy (CAE) and juvenile absence epilepsy (JAE), to determine the impact of failure of initial antiepileptic drug (AED) for lack of efficacy in eventual seizure control and long-term remission of epilepsy.Methods: Centralized EEG records for the province of Nova Scotia allowed identification of all children seen with CAE or JAE between 1977 and 1985. Information regarding success or failure of initial AED in fully controlling seizures and longterm seizure control and remission of epilepsy was collected by patient questionnaire and chart review.Results: Eighty-six of 92 eligible patients were followed up (75 CAE, 11 JAE). Initial AED treatment was successful in 52 (60%) of 86. Success tended to be greater for valproate (VPA) than for other AEDs (p ‫ס‬ 0.07), and lower if generalized tonic-clonic or myoclonic seizures coexisted (p < 0.004 and p < 0.03). Terminal remission was more likely if the initial AED was successful than if it had failed (69% vs. 41%; p < 0.02). Compared with those in whom the initial AED was successful, subjects whose initial AED had failed were more likely to progress to juvenile myoclonic epilepsy (JME) at last follow-up (32% vs. 10%; p < 0.02) and to develop intractable epilepsy (17% vs. 2%; p < 0.04).Conclusions: Initial AED was successful in 60% of children with AE. If the first AED failed, the outcome was less favorable, with a lower rate of terminal remission and a higher rate of progression to JME and intractable epilepsy. Key Words: Childhood absence epilepsy-Juvenile absence epilepsyAntiepileptic drug-Valproic acid.In children with epilepsy, if the initial antiepileptic drug (AED) fails to control seizures, the prognosis for seizure control is often thought to be poor. However, only two studies have looked at this question in the pediatric population. Camfield et al. (1) studied 417 children with partial, primary, and secondarily generalized seizures and found that 17% required a second AED for seizure control. Long-term remission of epilepsy occurred in 61% of children successfully treated with one medication versus only 42% of those requiring more than one AED for seizure control (p < 0.002). A second study looking at 24 children with partial epilepsy found that 29% achieved seizure control with a second AED (2).The prognostic significance of initial AED failure in children with absence seizures has not been published. We studied a population-based group of children with absence epilepsy to determine (a) how often absence seizures will be controlled after failure of the initial AED for lack of efficacy, and (b) whether failure of the initial AED predicts against long-term remission of absence epilepsy and for development of intractable epilepsy.

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Section: Discussionmentioning

confidence: 99%

Prognostic Significance of Failure of the Initial Antiepileptic Drug in Children with Absence Epilepsy

Wirrell

Camfield

et al. 2001

Epilepsia

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“…Table 1 shows the frequency of different seizure types in generalized epilepsy syndromes, and Table 2 shows the temporal profile of seizures in most of these syndromes (6,13,14–42). Tonic–clonic, absence, and myoclonic seizures occur in variable frequencies and patterns in the different IGEs, suggesting common neurochemical or anatomical pathways.…”

Section: Frequency Of Seizures In Idiopathic Generalized Epilepsy Synmentioning

confidence: 99%

Seizures of Idiopathic Generalized Epilepsies

et al. 2005

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Summary:Idiopathic generalized epilepsies (IGEs) comprise at least 40% of epilepsies in the United States, 20% in Mexico, and 8% in Central America. Here, we review seizure phenotypes across IGE syndromes, their response to treatment and advances in molecular genetics that influence nosology. Our review included the Medline database from 1945 to 2005 and our prospectively collected Genetic Epilepsy Studies (GENESS) Consortium database. Generalized seizures occur with different and similar semiologies, frequencies, and patterns, ages at onset, and outcomes in different IGEs, suggesting common neuroanatomical pathways for seizure phenotypes. However, the same seizure phenotypes respond differently to the same treatments in different IGEs, suggesting different molecular defects across syndromes. De novo mutations in SCN1A in sporadic Dravet syndrome and germline mutations in SCN1A, SCN1B, and SCN2A in generalized epilepsies with febrile seizures plus have unraveled the heterogenous myoclonic epilepsies of infancy and early childhood. Mutations in GABRA1, GABRG2, and GABRB3 are associated with absence seizures, while mutations in CLCN2 and myoclonin/EFHC1 substantiate juvenile myoclonic epilepsy as a clinical entity. Refined understanding of seizure phenotypes, their semiology, frequencies, and patterns together with the identification of molecular lesions in IGEs continue to accelerate the development of molecular epileptology.

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“…Recent retrospective data confirmed high rates of freedom from seizure, ranging from 77%–85% 31,32. Besides the disappearance of clinical absences, frequency and duration of generalized SWD were significantly reduced in more than 80% of cases 37.…”

Section: Treatment Of Typical Absencesmentioning

confidence: 86%

“…Furthermore, 61% of patients with “pure absences” were seizure-free. Recent retrospective data on large cohorts confirmed a high rate of freedom from seizures, ranging from 85%–90% 31,32. One prospective study including a placebo phase was published, but the study was not randomized 33.…”

Section: Treatment Of Typical Absencesmentioning

confidence: 99%

Current and emerging treatments for absence seizures in young patients

Vrielynck

2013

NDT

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In this report, we review the pharmacological and non-pharmacological treatments of the different absence seizure types as recently recognized by the International League Against Epilepsy: typical absences, atypical absences, myoclonic absences, and eyelid myoclonia with absences. Overall, valproate and ethosuximide remain the principal anti-absence drugs. Typical absence seizures exhibit a specific electroclinical semiology, pathophysiology, and pharmacological response profile. A large-scale comparative study has recently confirmed the key role of ethosuximide in the treatment of childhood absence epilepsy, more than 50 years after its introduction. No new antiepileptic drug has proven major efficacy against typical absences. Of the medications under development, brivaracetam might be an efficacious anti-absence drug. Some experimental drugs also show efficacy in animal models of typical absence seizures. The treatment of other absence seizure types is not supported with a high level of evidence. Rufinamide appears to be the most promising new antiepileptic drug for atypical absences and possibly for myoclonic absences. The efficacy of vagal nerve stimulation should be further evaluated for atypical absences. Levetiracetam appears to display a particular efficacy in eyelid myoclonia with absences. Finally, it is important to remember that the majority of antiepileptic drugs, whether they be old or new, may aggravate typical and atypical absence seizures.

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Absence epilepsy: early prognostic signs

Cited by 49 publications

References 26 publications

Prognostic Significance of Failure of the Initial Antiepileptic Drug in Children with Absence Epilepsy

Prognostic Significance of Failure of the Initial Antiepileptic Drug in Children with Absence Epilepsy

Seizures of Idiopathic Generalized Epilepsies

Current and emerging treatments for absence seizures in young patients

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