Follow‐up Study of 482 Cases With Convulsive Disorders in the First Year of Life

Abstract

SUMMARY A total of 482 patients who had had one or more seizures in the first year of life were followed for at least five years (most for more than 10 years). The patients were divided into four groups: febrile convulsions, infantile spasms, status epilepticus and ‘other’. Of those with febrile convulsions, 62 per cent developed normally, compared with 14 per cent in the group with infantile spasms, 15 per cent with status epilepticus, and 24 per cent in the ‘other’ group. Findings on recurrent seizures, epilepsy and mental retardation and/or neurological abnormalities are also reported. Epilepsy developed equally frequently among those with partial and with generalised seizures, but the former more frequently became mentally retarded. The effects of severity of seizures and other factors are discussed. In general, this research confirmed the grave prognosis after seizures during the first year of life, and not only for West syndrome and status epilepticus. The outcome was more favourable when the seizures were cryptogenic or febrile, isolated, with onset in the second six months, generalised, and when the EEG was normal between seizures. RÉSUMÉ Etude longitudinale de 482 cas de troubles convuisvs de la première année Un total de 482 sujets ayant présenté une ou plusieurs crises durant la première année de vie ont été suivis durant au moins cinq ans (la plupart plus de dix ans). Les sujets ont été divisés en quatre groupes, convulsions hyperthermiques, spasmes infantiles, état de mal épileptique et ‘autres’. Parmi les sujets à convulsions hyperthermiques, 62 pour cent se sont développés normalement, lc pourcentage étant de 14 dans le groupe de spasmes infantiles, de 15 dans le groupe d'état de mal, et de 24 dans le groupe ‘autres’. Les données sur une rechute des crises, I'épilepsie et Ie retard mental et/ou les anomalies neurologiques sont également décrites. I'épilcpsie est apparue également fréquemment en cas de crises focales ou généralisées mais les premières ont donné lieu plus fréquemment à des retards mentaux. Les effets de la gravité. des crises et d'autres facteurs sont discutés. En général. cette recherche confirme le pronostic sévère des crises de la première année de vie et pas uniquement pour le syndrome de West et I'état de mal. Le devenir a été optimal quand les crises étaient essentielles ou fébriles. isolées débutant dans le second semestre, généralisées et quand I'EEG edtait normal entre les crises. ZUSAMMENFASSUNG Kontrollstudie an 482 Fällen mit Krampfleiden im ersten Lebensjahr Insgesamt 482 Patienten, die im ersten Lebensjahr ein oder mehr Krampfanfälle hattén, wurden mindestens fünf Jahre (die meisten mehr als 10 Jahre) kontrolliert. Die Patienten wurden in vier Gruppen unterteilt: Fieberkrämpfe, BNS Krämpfe, Status epilepticus und ‘andere’. Von den Kindern mit Fieberkrämpfen entwickelten sich 62 Prozent normal, verglichen mit 14 Prozent in der Gruppe mit BNS Krämpfen und 15 Prozent in der mit Status epilepticus und mit 24 Prozent in der Gruppe ‘andere’. Befunde über rezidivierende Anfäll...

Outcome of convulsive status epilepticus: a review

“…Current estimates of case fatality associated with CSE in childhood range between 2.7% and 5.2% 1 9 – 15. This figure is 5–8% for children who are admitted to paediatric intensive care units 16 – 18.…”

“…The most common cause of CSE in childhood is prolonged febrile convulsions, which are generally associated with negligible morbidity and mortality 2 12 20 – 23. Although prolonged febrile convulsions are the most common form of CSE in children under 2 years of age, there is also a higher rate of acute symptomatic CSE, with the overall effect that CSE in young children has higher mortality rates (between 3% and 22.5%) than in older children 21 24 – 26. Most deaths in hospitalised children with CSE occur in cases where there is an identifiable associated systemic or neurological disease (symptomatic CSE)12 17 27 28; mortality is particularly high in cases of CNS infection and acute brain injury or anoxia 17 29.…”

“…Children with previous neurological abnormality and those with acute symptomatic CSE are more likely to develop epilepsy, with recurrent seizures occurring in more than 50% of these children. The most common type of epilepsy following an initial episode of CSE is focal,9 50 – 54 but generalised epilepsy, infantile spasms and Lennox-Gastaut syndrome are also reported 9 50 53. Unilateral CSE associated with a slight fever is common during the initial phases of the severe epilepsy syndrome, Dravet syndrome.…”

Surgery for medically intractable temporal lobe epilepsy during early life

“…Symptomatic and cryptogenic partial epilepsy that begin during infancy and early childhood is often catastrophic (Chevrie and Aicardi, 1978; Wyllie, 1996). Seizures rarely remit especially when associated with an obvious structural lesion (Chevrie and Aicardi, 1979; Cavazzuti et al, 1984). Uncontrolled seizures lead to neurological abnormalities and mental deterioration making long‐term prognosis poor (Chevrie and Aicardi, 1978; Cavazzuti et al, 1984; Wyllie, 1996).…”

Long‐term Follow‐up of Patients with Benign Partial Epilepsy in Infancy

“…In contrast, it has been generally accepted in European countries that most focal epilepsy that develops in infancy is symptomatic and that its prognosis for development and seizures is poor (7–10). However, after the first report by Watanabe et al, several more reports exist on focal epilepsy with favorable outcome beginning in early infancy (11–13).…”