EEG and Other Early Predictors of Epilepsy Remission: A Community Study

Shafer, Stephen Q.; Hauser, W. Allen; Annegers, John F.; Klass, Donald W.

doi:10.1111/j.1528-1157.1988.tb03767.x

Cited by 105 publications

(65 citation statements)

References 27 publications

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“…Age at onset was not a prognostic factor in our study, as it had not been in other investi gations [4,5,18]. Among the group with idio pathic epilepsy of Rochester [2], younger pa tients at diagnosis were more likely to become seizure-free.…”

Section: Prognosis Of Childhood Epilepsymentioning

confidence: 57%

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 Epilepsymentioning

confidence: 57%

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

et al. 1996

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“…Overall, about 30-40% of all patients with epilepsy have medically intractable seizures, and 50% of these are candidates for epilepsy surgery [2,20,44,53,80,196]. For the United States, it has been estimated that there are more than 100,000 candidates for surgical treatment, with 5,000-10,000 added annually [31,32,53].…”

Section: Introductionmentioning

confidence: 99%

Presurgical evaluation and surgical treatment of medically refractory epilepsy

Siegel

2004

Neurosurgical Review

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Thanks to today's modern imaging examination techniques and especially to the common use of intracranial electrodes for localizing seizure foci, more and more patients with partial epilepsy can be treated microsurgically. The results of such neurosurgical therapies are very good, particularly in mesial temporal lobe epilepsy. In recent years, good results (60-70% seizure freedom) have also been achieved in extratemporal epilepsy surgery, so that such procedures can now be recommended for carefully selected patients. In this review, presurgical evaluations and the different surgical approaches are presented.

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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: 86%

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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EEG and Other Early Predictors of Epilepsy Remission: A Community Study

Cited by 105 publications

References 27 publications

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

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

Presurgical evaluation and surgical treatment of medically refractory epilepsy

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

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