Predictive factors of seizure control in childhood onset epilepsy

Abstract

Background: Prediction of the long-term outcomes of childhood-onset epilepsy remains crucial for the future well-being of the affected children and their families and for planning proper therapeutic and educational programs. Objective: To identify and analyze the early predictive factors of seizure control in childhood-onset epilepsies referred at the age of 1 month up to the age of 18 years to the Epilepsy Service at the Meyer Children Hospital, Rambam Medical Center, Haifa, Israel. Materials and Methods: In this study, children who were newly diagnosed with epileptic disorders and treated with antiepileptic drug therapy - who became either completely controlled for at least twelve months or those remaining intractable - were included. Partially responding children were excluded from the analysis. The etiology was segregated into either symptomatic or nonsymptomatic epilepsy, referred to as idiopathic epilepsy. Results: Overall, 74 children (mean age: 4.27 ± 4 years at the first seizure) were found eligible for analysis followed for a mean period of 4.5 years. Fifty-three (72%) children became seizure-free for a mean period of 20 months on antiepileptic drug (AED) therapy and 21 (28%) remained uncontrolled. Sixty out of 74 children (81%) had idiopathic epilepsy and 14 (19%) had symptomatic epilepsy. In those with idiopathic epilepsy, 46 (77%) children gained complete seizure control in comparison to 7 out of 14 (50%) children in the symptomatic group ( P < 0.01). Thirty-nine out of 47 (83%) children who had normal cognition became seizure-free, and 14 (52%) out of 27 mentally retarded children also became seizure-free ( P < 0.01). The outcome of seizure control was not affected by age at onset and seizure type itself during the presentation. Conclusion: The present study reveals that the single most predictive factor of a favorable seizure control is preserved cognitive function in accordance with idiopathic epilepsy. However, a fairly high number of children with impaired cognition may also achieve satisfactory seizure control.