Long‐Term Prognosis of Convulsive Disorders in the First Year of Life: Mental and Physical Development and Seizure Persistence

Matsumoto, Akiko; Watanabe, Kazuyoshi; Sugiura, Midori; Negoro, Tamiko; Takaesu, Etsuko; Iwase, Katsuhiko

doi:10.1111/j.1528-1157.1983.tb04895.x

Cited by 49 publications

(22 citation statements)

References 12 publications

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“…Of the latter, the most common concomitant AEDs were only VPA in four children (6,8,9,13), and CBZ plus VPA in two patients (4 and 5). Other AEDs in the remaining six patients are listed in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…At the time of death, none of our patients had unusually high concentrations of these two or other AEDs. In the NZP group, six patients (4, 5,6,8,9,13) were taking VPA. None of these children had abnormal blood tests associated with VPA or serious side effects.…”

Section: Aeds and Deathmentioning

confidence: 99%

“…Cause(s) of death in children with epilepsy may be seizure-related events [e.g., suffocation, injury, drowning, aspiration, status epilepticus (SE), sudden unexplained death], event(s) unrelated to epilepsy, or suicide. The most common causes of death in children with epilepsy are pneumonia and bronchitis (1,6). In contrast to the situation with adults (7), SE is a rare cause of death in children with epilepsy (8).…”

mentioning

confidence: 99%

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Incidence of Death in Patients with Intractable Epilepsy During Nitrazepam Treatment

et al. 1999

Epilepsia

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Summary:Purpose: Increased risk of death has been reported in patients with intractable epilepsy (IE) taking nitrazepam (NZP).Methods: Between January 1983 and March 1994, 302 patients with IE were entered into a NZP compassionate-plea protocol. NZP was discontinued if there was 4 0 % seizure reduction or significant side effects. In some patients with >SO% reduction, it also was discontinued for lack of sufficient effect. At the end of follow-up for this study, 62 patients remained taking NZP. Patients took NZP from 3 days to 10 years.Results: Twenty-one of 302 patients died after institution of NZP. Fourteen of 2 1 of these were taking NZP at death, and in five of 2 1, the NZP had been discontinued. Two patients were excluded from analysis, because it is unclear whether NZP had been discontinued before death. Six other patients were lost from follow-up. Of the 14 deaths with NZP, seven were sudden, six were of pneumonia, and one was of cystinosis. Nine had at least one contributing factor, such as dysphagia, gastroesophageal reflux, or recurrent aspirations. The 294 patients took NZP for a total of 704 patient years (ptyrs), and were discontinued for a total of 856 ptyrs. There were I .98 deaths/ 100 ptyrs on NZP compared with 0.58 deaths/[ 00 ptyrs without NZP, most of the former being associated with side effects of NZP. Mortality in patients younger than 3.4 years was 3.98 with NZP compared with 0.26 deathdl00 ptyrs without NZP (p = 0.0002). Corresponding figures in patients 3.4 years or older were 0.50 and 0.86 deathdl00 ptyrs, respectively.Conclusions: NZP therapy for epilepsy apparently increases the risk of death, especially in young patients with IE. This should be considered in antiepileptic drug (AED) management decisions.

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Section: Resultsmentioning

confidence: 99%

Section: Aeds and Deathmentioning

confidence: 99%

mentioning

confidence: 99%

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Incidence of Death in Patients with Intractable Epilepsy During Nitrazepam Treatment

et al. 1999

Epilepsia

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“…• There is no high-level evidence to support any particular current agents for use in infants with seizures. Overall, infantile (epileptic) spasms constitute the largest single epilepsy subgroup, representing 13-45.5% of infantile population-based incidence studies 44,47,[52][53][54][55][56] For other seizure types there are limited data beyond case series (class 3 and 4 studies) The outcomes reported in typically class 4 studies suggest that seizures in infancy are predictive of comorbidities as well as complex and poor outcomes 52,53,55 Clinical semiology/ types of epileptic events…”

Section: Methodsmentioning

confidence: 99%

Summary of recommendations for the management of infantile seizures: TaskForceReport for theILAE Commission ofPediatrics

et al. 2015

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Summary Evidence‐based guidelines, or recommendations, for the management of infants with seizures are lacking. A Task Force of the Commission of Pediatrics developed a consensus document addressing diagnostic markers, management interventions, and outcome measures for infants with seizures. Levels of evidence to support recommendations and statements were assessed using the American Academy of Neurology Guidelines and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The report contains recommendations for different levels of care, noting which would be regarded as standard care, compared to optimal care, or “state of the art” interventions. The incidence of epilepsy in the infantile period is the highest of all age groups (strong evidence), with epileptic spasms the largest single subgroup and, in the first 2 years of life, febrile seizures are the most commonly occurring seizures. Acute intervention at the time of a febrile seizure does not alter the risk for subsequent epilepsy (class 1 evidence). The use of antipyretic agents does not alter the recurrence rate (class 1 evidence), and there is no evidence to support initiation of regular antiepileptic drugs for simple febrile seizures (class 1 evidence). Infants with abnormal movements whose routine electroencephalography (EEG) study is not diagnostic, would benefit from video‐EEG analysis, or home video to capture events (expert opinion, level U recommendation). Neuroimaging is recommended at all levels of care for infants presenting with epilepsy, with magnetic resonance imaging (MRI) recommended as the standard investigation at tertiary level (level A recommendation). Genetic screening should not be undertaken at primary or secondary level care (expert opinion). Standard care should permit genetic counseling by trained personal at all levels of care (expert opinion). Genetic evaluation for Dravet syndrome, and other infantile‐onset epileptic encephalopathies, should be available in tertiary care (weak evidence, level C recommendation). Patients should be referred from primary or secondary to tertiary level care after failure of one antiepileptic drug (standard care) and optimal care equates to referral of all infants after presentation with a seizure (expert opinion, level U evidence). Infants with recurrent seizures warrant urgent assessment for initiation of antiepileptic drugs (expert opinion, level U recommendation). Infantile encephalopathies should have rapid introduction and increment of antiepileptic drug dosage (expert opinion, level U recommendation). There is no high level evidence to support any particular current agents for use in infants with seizures. For focal seizures, levetiracetam is effective (strong evidence); for generalized seizures, weak evidence supports levetiracetam, valproate, lamotrigine, topiramate, and clobazam; for Dravet syndrome, strong evidence supports that stiripentol is effective (in combination with valproate and clobazam), whereas weak evidence supports that topiramate, zonisamide,...

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“…20 Based on epidemiologic searches, epileptic spasms are the most common infantile epilepsy, representing 13-45.5% of all epilepsies in this time period. [21][22][23][24][25][26] There is a plethora of studies regarding the management of epileptic spasms, but only steroids and vigabatrin have shown demonstrable efficacy in well-conducted clinical studies. 10,27 The respondents were mostly in-line with these recommendations, but there remained some variations regionally.…”

Section: Discussionmentioning

confidence: 99%

Treatment of infants with epilepsy: Common practices around the world

et al. 2015

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SUMMARYObjectives: High quality data to guide recommendations for infants with epilepsy are lacking. This study aimed to develop an understanding of common practice and regional variations in the treatment interventions of infants with epilepsy, and also to identify areas for further study and to highlight where common practice occurs without sound evidence. Method: A survey addressed clinical treatment practice for infants with epilepsy. Alternative interventions were included. Results: The survey found that most regions had similar practice for first-line interventions, except for North America, where more levetiracetam was prescribed. There was a preference for valproate as first-line therapy for generalized seizures, myoclonic seizures, and Dravet syndrome; only Oceania differed for generalized and myoclonic seizures. Phenobarbital was used for generalized and focal seizures in resource-poor and resource-equipped regions. Carbamazepine and oxcarbazepine were the preferred agents for focal seizures from all regions except North America, which uses more levetiracetam. For second-and third-line interventions, the range of choices was diverse, often with little correlation across regions. The ketogenic diet, vagus nerve stimulation, and epilepsy surgery were considered viable choices in most settings, but usually only once seizures were considered medically refractory. The survey highlighted the marked discrepancy in Africa, the one region that consistently confirmed a lack of access to these alternative interventions and to the newer antiepileptic drugs. Significance: More randomized controlled trials in infants with seizures are needed to permit useful recommendations. The survey identified widespread use of levetiracetam in North America, which may be the result of effective marketing or based on good clinical practice. The widespread use of valproate may have safety implications. The lack of access to care in the African region highlighted the need for more sustained resources. Although the survey was not evidence based, the findings could be useful to support additional well-designed studies.

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Long‐Term Prognosis of Convulsive Disorders in the First Year of Life: Mental and Physical Development and Seizure Persistence

Cited by 49 publications

References 12 publications

Incidence of Death in Patients with Intractable Epilepsy During Nitrazepam Treatment

Incidence of Death in Patients with Intractable Epilepsy During Nitrazepam Treatment

Summary of recommendations for the management of infantile seizures: TaskForceReport for theILAE Commission ofPediatrics

Treatment of infants with epilepsy: Common practices around the world

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