Clinical Evolution and Prognosis of Childhood Epilepsies

Sofijanov, N

doi:10.1111/j.1528-1157.1982.tb05053.x

Cited by 70 publications

(32 citation statements)

References 12 publications

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“…While Annegers et al [2] found remission rates higher in patients with generalized seizures than in sub jects with seizures that were focal at onset in their idiopathic group, in our patient popula tion the seizure type did not influence the out come of clinical control. This finding is in agreement with another report which grouped together all epilepsy syndromes in children [15], Partial seizures had a worse prognosis also in the Elwes study [4], and the co-exis tence of several main types of seizures led to a less favourable outcome in an incidence co hort of children without neurodeficit aged 0-19 years and in other studies [16,17], On the other hand, the lack of effect of partial versus generalized seizures in our study can not be related to the proportion of cases with benign rolandic epilepsy. There is no general agree ment on the prognostic value of age at the onset of epilepsy.…”

Section: Prognosis Of Childhood Epilepsysupporting

confidence: 83%

Prognosis of Childhood Epilepsy: A Community-Based Study in Copparo, Italy

et al. 1996

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We performed a community-based study among children and adolescents with idiopathic and cryptogenic epilepsy and onset of the seizures between 0 and 19 years of age on the prognosis of being seizure-free. The study population was recruited during a descriptive investigation in the Local Health Service of Copparo (USL 34), Ferrara, Northern Italy. We included 111 patients (61 males and 50 females). The average length of follow-up was 18.8 years (ranging from 7 to 24 years). The cumulative probability of being in remission was 81.2% at 15 years after onset and the estimated percentage of patients in remission without therapy was 56 % for the same time period. At 15 years after the onset of epilepsy, approximately 20% of patients continued to have seizures; nearly 25% continued to take antiepileptic drugs but had been free of seizures for at least 5 years; nearly 56% had been without seizures and free of medication for at least 5 years. Seizure type, gender, age at onset of the illness, epileptic abnormalities on EEG, family history of convulsive disorders, number and frequency of seizures prior to the start of treatment were found not to be helpful as prognostic factors. This community study, carried out on patients without the well known factors that adversely affect prognosis, confirms that the prospect of seizure control and for withdrawal of therapy is (generally) good.

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Section: Prognosis Of Childhood Epilepsysupporting

confidence: 83%

Prognosis of Childhood Epilepsy: A Community-Based Study in Copparo, Italy

et al. 1996

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“…In our study, the prognosis after 2 years was good in almost 60% and poor in -30%. One may expect the proportion with a poor outcome to become smaller after longer follow-up, in accordance with the results of earlier studies (4,7,8,23) that concentrated on the long-term outcome. One of the most conspicuous findings of our study is the relatively good outlook early in the course of the disease (i.e., at 2 years of follow-up).…”

Section: Figsupporting

confidence: 78%

The Early Prognosis of Epilepsy in Childhood: The Prediction of a Poor Outcome. The Dutch Study of Epilepsy in Childhood

et al. 1999

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Summary:Purpose: To examine which variables available early in the course of childhood epilepsy are associated with a poor short-term outcome and to develop models to predict such an outcome.Methods: We prospectively followed up 466 children with newly diagnosed epilepsy for 2 years. Variables were collected at intake and after 6 months. Outcome was defined as the duration of the terminal remission (TR): poor (<6 months) and not poor ( 2 6 months).Results: Of the subjects, 3 1 % had a poor outcome. Multivariate analysis based on the intake variables identified number of seizures, seizure type, and etiology as risk factors for a poor outcome. With the intake and 6-month variables combined, seizure type, etiology, the number of seizures, and not attaining a 3-month remission during these 6 months, and the EEG at 6 months were predictive variables. A predictive model based on the multivariate logistic-regression analysis with the intake variables was correct in 56% of the children in whom it predicted a poor outcome and in 73% of the children in whom it predicted a not-poor outcome. With the intake and 6-month variables together, these percentages were 66 and 79%, respectively. The sensitivity of these models was low (29 and 47%, respectively); the specificity was good (90 and 89%).Conclusions: The 2-year outcome of childhood epilepsy is closely related to its early course. The prognosis is poor in -30% of patients. By using our data, the prediction of a poor outcome is correct in almost two thirds of the patients; however, the models produce many false-negative predictions.

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“…24 Associations between low IQ and poor seizure control have been found in several studies, [25][26][27][28][29] as has motor disability. 2,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] A significant predictor in this study was multiple types of seizure, a relatively unreported finding. 2,38 It is possible that the average delay of 15 months from seizure onset to assessment allowed time for other seizure types to appear.…”

Section: Discussionmentioning

confidence: 85%

Prediction of seizure outcome in childhood epilepsies in countries with limited resources: a prospective study

Banu

Khan

Hossain

et al. 2012

Develop Med Child Neuro

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AIM To identify predictors of seizure control in newly presenting children with epilepsy in countries with limited resources.METHOD Three hundred and ninety children (273 males, 117 females) aged 2 months to 15 years with newly diagnosed epilepsy were enrolled prospectively at first visit to the multidisciplinary clinic at the children's hospital in Dhaka, Bangladesh. Data about seizures, motor disability, psychomotor development, and electroencephalography were obtained. Regular monitoring of antiepileptic drug treatment was continued at least for one year. Associations between seizure control and potential predictors were determined by multivariate analysis.RESULTS Three hundred and ninety children were enrolled in 6 months, of whom over 60% were from low-income families, 60% had onset at under 1 year, 74% had more than one seizure per week, 69% a single-seizure type, and 38% a history of delayed onset of breathing at birth. Cognitive deficits (IQ<70; 58%) and ⁄ or motor (significant limitation of daily living activities; 47%) deficits were common. After 1 year of regular treatment, seizure control was good (seizure freedom) in 53%, and poor (at least one seizure in the last 3mo of follow-up) in 47%. The predictors of poor seizure control were an IQ<70, associated motor disability, multiple seizure types, and a history of cognitive regression (1.9 times more likely to have poor seizure control).INTERPRETATION Seizure control can be predicted using three clinical factors (motor disability, cognitive impairment, and multiple seizure types) at the first clinic visit. Such predictors assist the development of referral plans and management guidelines for childhood epilepsies in resourcepoor countries.The management of childhood epilepsy in countries with limited resources has several specific problems. These include lack of medical resources, misunderstanding of the nature of epilepsy, stigmatization, large treatment gaps (i.e. a high percentage of the target population not receiving medication but often a high level of use of traditional healers), and a lack of understanding of the priorities of the users by those seeking to provide treatment. All of these issues arise in the management of epilepsy in children in Bangladesh. In consultation with parents, we formed the view that the ability to predict seizure control with future treatment can be useful. First, it provides an audit so that if the control is widely discrepant from that predicted, a reason may be sought (e.g. seizures were not epileptic, antiepileptic drugs were not taken). Second, it gives the family and patient an expectation of what antiepileptic drugs can achieve and whether they are essential to management. Third, it allows an approximate cost-benefit analysis to be performed. These may be useful in any setting, but in a country with limited resources (e.g. Bangladesh) this may allow doctors and carers to deploy their resources more effectively. The second broad issue raised was the high rate of additional problems of development and behaviour th...

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Clinical Evolution and Prognosis of Childhood Epilepsies

Cited by 70 publications

References 12 publications

Prognosis of Childhood Epilepsy: A Community-Based Study in Copparo, Italy

Prognosis of Childhood Epilepsy: A Community-Based Study in Copparo, Italy

The Early Prognosis of Epilepsy in Childhood: The Prediction of a Poor Outcome. The Dutch Study of Epilepsy in Childhood

Prediction of seizure outcome in childhood epilepsies in countries with limited resources: a prospective study

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