Outcome at age 7 of epilepsy presenting in the first 2 years of life. A population‐based study

Abstract

Objective Existing data suggest that epilepsy presenting in the first few years of life carries a worse prognosis than later onset. However, studies are few and methods differ, making interpretations of data uncertain. This study analyzes outcome at age 7 and potential prognostic factors in a well‐characterized population‐based cohort with epilepsy onset during the first 2 years of life. Methods An incidence cohort of 116 prospectively identified cases of epilepsy with seizure onset before age 2 years was described in Stödberg et al. (2020). Cases were originally retrieved from the Stockholm Incidence Registry of Epilepsy (SIRE), which registered all cases with a first unprovoked epileptic seizure from September 1, 2001, in Northern Stockholm. Data on treatment and outcome at age 7 years were collected from electronic medical records and through interviews with parents. Outcome and potential prognostic factors were analyzed with descriptive statistics and multivariable log binomial regression analysis. Results Eleven children (9.5%) died before age 7. Polytherapy was common. Epilepsy surgery was performed in two children. At age 7 years, 61 of 116 children (53%) had been seizure‐free for the last 2 years or longer. Intellectual disability was diagnosed in 57 of 116 children (49%), autism spectrum disorder in 13 (11%), and cerebral palsy in 28 (24%). West syndrome had a similar seizure remission rate but a worse cognitive outcome. There was no difference in outcome between first and second year onset. Six predictors, including etiology, remained associated with two or more outcome variables after regression analysis. Significance About half of children with infantile‐onset epilepsy will become seizure‐free and half of them will have intellectual disability. Etiology was confirmed as a major independent predictor of outcome. Our study contributes to a more firm knowledge base when counseling parents of infants diagnosed with epilepsy.

Epilepsies with onset during the first year of life: A prospective study on syndromes, etiologies, and outcomes

“…The outcome of infantile epilepsy is often unfavorable, shown by global delay in just over half and pharmacoresistance in more than one third of the individuals in the present study. Developmental outcome was similar to the recent Swedish and Scottish studies which both reported 49% with global developmental delay or intellectual disability at the end of follow‐up 1,13 . Similarly, both previous research and our study agree on treatment resistance existing in around one third of cases 2,22,23 .…”

“…Etiology as the most important determinant of prognosis has been proven in recent prospective studies 1,2 . In the past, identified etiology, especially structural causes, 3 has been associated with worse outcomes.…”

Cannabidiol Treatment for Lennox-Gastaut Syndrome at a Single Tertiary Center in South Korea

“…One of our key findings was that the patients responded better to CBD treatment when epilepsy onset occurred at an age >3 years (OR, 10.11; 95% CI, 1.05 to 97.00; P=0.045). Several previous studies have suggested that the outcome of epilepsy with an earlier onset (in the first few years of life) has a worse prognosis than that with a later onset [16,17]. An earlier onset of epilepsy is caused by structural abnormalities in the brain, such as cerebral malformations, neurometabolic diseases, and perinatal hypoxic-ischemic encephalopathy, which are significantly associated with treatment response to ASMs [18].…”

Quality of life of children with residual seizures after epileptic resection surgery

“…This may be a feature of pediatric epilepsy, where epilepsy onset in childhood has a large impact on intellectual development. Fifty-three percent of children with epilepsy onset before the age of 2 years have a combined intellectual disability of 7 years ( 29 ). A total of 24.4% of children in our cohort had delayed language development or language dysfunction.…”