Childhood Epilepsy: What Is the Evidence for What We Think and What We Do?

Abstract

This article reviews the strength of the evidence that underlies the current approach to the management of childhood epilepsy. The authors reviewed published, peer-reviewed English literature accessed through PubMed and Cochrane reviews with evidence rated as Class 1 (strongest) to Class 4 (weakest). There is considerable inaccuracy in the diagnosis of seizures and epilepsy syndromes. Sound information supports the consensus that the diagnosis of epilepsy should await two unprovoked seizures. Population-based studies indicate that remission from childhood onset epilepsy occurs in at least 50% of children. It is easier to predict a good seizure outcome than a poor one. Absence of concomitant neurologic handicap and onset before about 12 years of age are the most consistent predictors of remission. Intractability is poorly defined and difficult to predict until several antiepilepsy drugs have been used and failed to control the seizures. Most epilepsy syndrome diagnoses do not yield an accurate prognosis. Social outcome appears unsatisfactory in about 50% of cases without intellectual handicap. Death is rare in childhood epilepsy. Those without severe neurologic handicaps have the same mortality as the general population. We identified only 27 published randomized trials of antiepilepsy drugs in children that compare the efficacy of antiepilepsy drugs, offer treatment of syndromes currently without successful treatment, or have negative effects. There is a pressing need for better definitions of seizures and epilepsy syndromes. The causes of poor social outcome are unclear. Intractability needs a clear definition and randomized trials comparing treatment regimes are sadly lacking.

Mapping the landscape of cognitive development in children with epilepsy

“…There is now considerable agreement that childhood onset epilepsy disrupts this systematic developmental process with adverse impact on executive function (Bell, Lin, Seidenberg, & Hermann, 2011; D’Agati, Cerminara, Casarelli, Pitzianti, & Curatolo, 2012; Seidenberg et al, 1986), academic skills (Berg et al, 2005; Seidenberg et al, 1986), linguistic abilities (Caplan et al, 2008; Caplan et al, 2009) and emotional/behavioral quality of life (Berg et al, 2008; C. Camfield, Breau, & Camfield, 2003; P. Camfield & Camfield, 2003).…”

Survey of administration of medicines to pupils in primary schools within the London area

“…1 The number of children of school age receiving medical treatment is rising and the treatment is becoming more complex. Children need to take prescribed medicines during school time for various reasons, such as asthma, 2 epilepsy, 3 diabetes, 4 severe allergy, 5 and attention deficit hyperactivity disorder. 6 There have been suggestions that children with medical needs are excluded from school because insufficient support is provided by schools.…”

Stopping Antiepileptic Drugs: When and Why?

“…Several pediatric epilepsy syndromes are known to naturally reach a period of remission in all cases, whereas others have a more uncertain prognosis [31]. About 10% of childhood epilepsy syndromes, including syndromes such as juvenile myoclonic epilepsy and reading epilepsy, will never remit, and thus an AED withdrawal trial would not be advisable, even after a period of seizure freedom [22].…”