Childhood epilepsy: a study of etiological and prognostic factors for failure of remission at a tertiary care government hospital, a prospective COHORT study

Abstract

Background: This study was carried out to identify early predictive factors of medically intractable childhood epilepsy. We also aimed to explore the prognosis in terms of remission with anti-epileptic drug (AED) treatment and to identify the predictors of poor prognosis (failure of remission) in relation to the control of epilepsy.Methods: Children with epilepsy were included. Information recorded at the time of the first visit: age, gender, age at onset of epilepsy, patient history, AED treatment and Seizure control. Details of general and neurological examination were also recorded. These patients were then followed up over a one-year period to assess for remission and patient compliance with medication.Results: A total of 239 patients between the ages of 1 month and 12 years were diagnosed with epilepsy according to the International league against epilepsy (ILAE) classification. Of these 213 patients followed up. Among these, 126 (59.1%) patients attained remission while 87 (40.8%) patients failed to attain remission. Age of onset less than 1 year, microcephaly, developmental delay at diagnosis, a definite etiology, infantile spasms, structural abnormality detected on neuroimaging, abnormal electro-encephalography (EEG) and the requirement for polytherapy to achieve seizure control were found to be associated with a poor prognosis (failure of remission).Conclusions: The poor prognostic factors for childhood epilepsy at diagnosis are age of onset <1 year, microcephaly, infantile spasms, structural abnormality on neuroimaging and abnormal EEG. At follow up patients requiring an add-on AED to pre-existing treatment regimen is associated with a lesser likelihood of achieving remission.