The Late Prognosis of Epilepsy in Childhood: Results of a Prospective Follow‐up Study

Abstract

By means of a prospective study, relapse after discontinuation of antiepileptic drug treatment in 433 children with epilepsy and 40 patients who were treated after the first seizure was investigated. Independent of the electroencephalographic findings, the age of the patients, and other factors, the antiepileptic drugs were reduced during 1, 3, 6, and 12 months after 2, 3, and 4 seizure-free years; and in children with absences after 1, 2, 3, and 4 seizure-free years. The observation period after stopping therapy was at least 3 (on average, 5-6) years. In 157 of 433 children (36.3%) and 5 of 40 patients (12.5%), relapses occurred during this time. More than half (61.8%) of the relapses occurred during the withdrawal period or within 3 months: altogether, 86% within 1 year after discontinuation of therapy. Eighty-six percent of these patients again became free from seizures on administration of the original therapy. The dependence on predictive factors of the rate of relapse was tested by multivariate statistical analysis. There was a pronounced significant dependence on the duration of the seizure-free period, the duration of the withdrawal period, the length of illness, the frequency and duration of seizures, and the presence of paroxysmal activity in the EEG at the start of the discontinuation of antiepileptic drug treatment. The stopping of therapy during the pubertal period did not present a higher risk.

Early Discontinuation of Treatment in Children with Uncomplicated Epilepsy: A Prospective Study with a Model for Prediction of Outcome

“…The duration of the period of AED discontinuation did not influence the outcome in our study, a finding similar to that of Tennison et al (28) but one that contradicts the results of other reports (9,25). Because our study was not designed to analyze this variable, it is difficult to make conclusions about its importance.…”

“…Almost all the studies performed in the last few decades (4,5,8,(17)(18)(19)27) have used a seizure-free period of at least 2 years as the cutoff point for discontinuation of treatment. Studies that analyzed outcome in relation to different seizure-free periods before treatment discontinuation have shown that the seizure-free period correlated positively to favorable outcome (9,25). In accordance with the design of the present study, the seizure-free period was restricted to 0.5-3 years (mean 1.6 years; 0.8 years in group I and 2.4 years in group 11).…”

“…Our study mainly concerns children with idiopathic epilepsy; many variables of predictive importance determined in earlier studies can be referred to epilepsies secondary to structural brain lesions. These variables include neurological abnormalities (3-7), a history of perinatal complications (16), and a high seizure frequency before initiation of treatment (3,5,23,25,26)variables not related to outcome in our study. The outcome of children with neurological impairments in our study (MMR and ADHD/DAMP) did not differ from that of children without such impairments (relapse rate 33% and 38%, respectively).…”

Role of Ct Scan in Partial Seizures in Children

“…Thus the incidence of positive results was 66%. Tuberculoma (Fig 1) was seen in 12 cases, cortical atrophy/porencephalic cyst (Fig 2) in 7, calcification (Fig 3) in 5, meningoencephalitis and vascular problem/haematoma (Fig 4) in 4 each and a subdural effusion in 1 ( Table 1). Table 2).…”

“…Therefore it becomes important to arrive at an etiological diagnosis whenever possible to aid specific therapy. Almost 30% of patients with a seizure disorder are children [2] and the seizure type is partial in 23-66% of children [3][4][5]. Routinely used methods including the EEG in most cases cannot localise the lesion.…”