Abstract
Background Children with epilepsy with onset above five years encompass distinct epidemiological and clinical characteristics that may have specific risk factors for resistance to antiseizure medications (ASMs). Studies on this age group are limited. Purpose To identify risk factors for drug resistance in children with epilepsy with the age of onset above five years. Methods A case-control study was conducted on children with epilepsy with the age of onset above five years visiting the Pediatric Neurology Clinic of Cipto Mangunkusumo and Mohammad Hoesin Hospital between September 2015 and August 2016. Cases consisted of drug-resistant children while control consisted of drug-responsive children according to 2010 ILAE classification. Risk factors studied include onset, number of seizures, illness duration before treatment, cause, seizure type, status epilepticus, initial and evolution of EEG, brain imaging, and initial treatment response. Results Thirty-two pairs of children were included in the study. After logistic regression analysis, symptomatic etiology and failure to achieve early response to treatment were found to be associated with drug resistance with adjusted OR of 84.71 (95% CI: 5.18-1359.15) and 72.55 (95% CI: 7.08-743.85), respectively. Conclusion Poor initial response to ASM and symptomatic etiology are independent risk factors for drug resistance in children with epilepsy with the age of onset above five years.
Highlights
Epilepsy is the most common neurological disorder, affecting 50 million people worldwide, with approximately 80% living in developing countries with limited resources
Cases consisted of children with antiseizure medications (ASMs) resistance based on International League Against Epilepsy (ILAE) definition which is the failure to achieve sustained seizure freedom after administration of two or more appropriately chosen and used ASM schedules, while controls consisted of children who achieved sustained seizure freedom, defined as no seizure for at least 12 months or three times pretreatment interseizure interval, using two or fewer ASM schedules [6]
Symptomatic epilepsy was identified in 26 children; most had hippocampal atrophy with or without sclerosis (7 children)
Summary
Epilepsy is the most common neurological disorder, affecting 50 million people worldwide, with approximately 80% living in developing countries with limited resources. Children with epilepsy with onset above five years encompass distinct epidemiological and clinical characteristics that may have specific risk factors for resistance to antiseizure medications (ASMs). Studies on this age group are limited. To identify risk factors for drug resistance in children with epilepsy with the age of onset above five years. A case-control study was conducted on children with epilepsy with the age of onset above five years visiting the Pediatric Neurology Clinic of Cipto Mangunkusumo and Mohammad Hoesin Hospital between September 2015 and August 2016. Poor initial response to ASM and symptomatic etiology are independent risk factors for drug resistance in children with epilepsy with the age of onset above five years
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