Outcome Of Childhood Epilepsy Research Articles

Is there a relationship between socioeconomic factors and prevalence, adherence and outcome in childhood epilepsy? A systematic scoping review.

Socioeconomic factors play a role in the outcome of chronic diseases in childhood. Epilepsy is the most common chronic neurological disease in childhood. The relationship between socioeconomic factors and prevalence, adherence and outcome in children with epilepsy has not been systematically reviewed and therefore the aim of our study. Searches were conducted in PubMed, Embase and Cochrane databases from the first documented publications until 31st May 2020. The keywords included socioeconomic status, epilepsy, anticonvulsant, children and systematic review. The search generated 4687 abstracts. 26 articles were included in the final analysis after the screening process. We found one paper regarding prevalence, 12 regarding adherence and 13 regarding outcome and their relationship to socioeconomic factors. Socioeconomic factors of caregivers impacted school performance, seizure freedom, quality of life and risk of unemployment in adulthood. Lower socioeconomic status was associated with non-adherence. Epilepsy may be more prevalent in children living in lower socioeconomic neighborhoods. Socioeconomic factors of the caregiver, especially their level of education, annual income and marital status, had a significant impact on the outcome and adherence to anticonvulsants in children with epilepsy. Children belonging to a lower socioeconomic group are at risk of having poorer outcomes regarding adherence and hence remission, quality of life and academic achievement. We need to recognize this important aspect and take it into account when making a treatment plan for children with epilepsy.

Long-term seizure and psychosocial outcome in childhood epilepsy of unknown cause.

The purpose was to investigate long-term prognosis of epilepsy of unknown cause with onset between ages 2 and 16 in children without any major disability, by evaluation of a previously described prognostic model and long-term follow-up of a study on the impact of duration of initial antiseizure medication (ASM) treatment. Patients included in a randomized controlled trial (RCT) of either one or three years of ASM therapy prior to withdrawal (if seizure-free for at least 6months) were contacted after 29-35years and asked to complete a survey. Potential prognostic factors were evaluated: duration of initial ASM treatment, seizure type, seizure frequency, and score in a prognostic model developed in the initial publication. One hundred and forty-nine subjects answered the questionnaire (response rate 65%). Seizure freedom without treatment was found in 110 responders (77%, 95%CI: 73-81). There was no significant difference in score in the prognostic model between responders with and without epilepsy at follow-up. Those with active epilepsy were unemployed significantly more often and perceived their mental health significantly more affected than those seizure-free without treatment. Duration of initial ASM treatment was not associated with any difference in subsequent epilepsy risk. This indicates that the timing of withdrawal attempts is unlikely to alter the long-term prognosis of uncomplicated childhood epilepsy. The failure of the prognostic model from the initial study to predict long-term outcome argues that although prediction of relapse risk in the shorter term may be possible, the bearing of such models on long-term epilepsy risk is more questionable.

Short-term treatment outcome of childhood epilepsy in Jos, Nigeria

Background: Childhood epilepsy causes tremendous burden for the child, the family, the society and the healthcare system. While the majority of patients with epilepsy respond well to one antiepileptic drug (AED), many respond poorly to antiepileptic therapy with two or more AEDs, or develop drug-resistant epilepsy (DRE). We evaluated the short-term treatment outcomes of childhood epilepsy at a tertiary hospital in Nigeria. Methods: We reviewed the clinical records of newly diagnosed children with epilepsy that were commenced on AEDs from January 2011 to December 2015 and completed follow-up for at least 2 years. We evaluated their treatment outcomes and studied the association between the treatment outcomes and patients’ characteristics. Results: Three hundred and twenty-six patients met the eligibility criteria. The remission rate was 64.1%, the relapse rate at 2 years was 5.3% while the prevalence of drug-resistant epilepsy was 19.9%. Children with focal seizures were 1.5 times more likely to achieve remission compared to those with generalized seizures (adjusted odds ratio = 1.52; P = 0.008). Similarly children with normal neurologic examination were about 6 times more likely to achieve remission compared to those with abnormal neurologic examination (adjusted odds ratio = 5.79; P

Psychiatric comorbidity in children and youth with epilepsy: An association with executive dysfunction?

Psychopathology in children and youth with epilepsy has previously been related to executive dysfunction, but the nature of the association is uncertain. We sought to explore risk factors for psychiatric disorders in children and youth with epilepsy, with emphasis on executive dysfunction, along with seizure-related and psychosocial factors. The cohort consisted of one hundred and one consecutive patients aged 10-19 years with focal (n=52) or genetic generalized (n=49) epilepsy. All were screened for psychiatric symptoms, using part of an extensive questionnaire, the Strengths and Difficulties Questionnaire (SDQ) for both patients and their parents. Participants scoring in the borderline or abnormal range on the SDQ received a psychiatric interview (Kiddie-SADS-PL). All participants underwent a neuropsychological examination, and those with general cognitive abilities (IQ)<70 were excluded. Forty-seven of 101 participants (46.5%) had a SDQ score in the borderline or abnormal range and underwent a psychiatric evaluation. Of these, 44 (93.6%) met the criteria for a psychiatric diagnosis, the most common being ADHD and anxiety. An executive deficit was identified in 26.8% of the participants with a psychiatric diagnosis, but in only 5.4% of those without such a diagnosis (p=0.003). Multivariate logistic regression analysis showed that executive dysfunction was an independent risk factor for having a psychiatric disorder (OR 8.2, CI 1.8-37.2, p=0.006), along with male gender (OR 2.9, CI 1.2-7.3, p=0.02), and early seizure onset (0.86-that is one year older equals risk of psychiatric disorder reduced by 14%-CI 0.77-0.96, p=0.01). Other epilepsy-related or psychosocial factors were not significantly associated with psychiatric disorders. Multiple factors are associated with psychiatric problems in children and youth with epilepsy. In this study, executive dysfunction, male gender, and early epilepsy onset were independent risk factors for having a psychiatric disorder. An evaluation of psychiatric and cognitive problems is important to enable a positive long-term outcome in childhood epilepsy.

Profile of childhood epilepsy in Nigeria

Epilepsy is the most common neurological disorder, affecting individuals in all age groups. It is estimated that there are about 50 million people with epilepsy worldwide, of which about two-thirds are children and the greatest burden is found in the developing world. There is little data on the burden or pattern of epilepsy in the developing countries, particularly in children living in sub-Saharan Africa. This study was carried out to determine the pattern, predisposing factors and outcome of childhood epilepsy among children seen at the University College Hospital, Ibadan, Nigeria. All new cases of epilepsy seen consecutively over a period of 5 years in the Pediatric Neurology clinic of the University College Hospital, Ibadan, Nigeria were studied. Diagnosis of epilepsy was based on reliable eyewitness account and EEG findings. Five hundred and forty children, 321 males and 219 females were studied. Their ages ranged from 3 to 184 months with a mean age of 74.8 ± 47.9 months and median of 71.5 months. One third of the children had the first afebrile seizure in the first year of life. Generalized epilepsy, found in 67.8% of cases was the predominant form of epilepsy in the study. Two hundred and fifteen (39.8%) children had symptomatic epilepsy, with intracranial infections and perinatal asphyxia as the leading underlying causes. By the end of the first year, up to three quarters of the children had defaulted from follow up. Epilepsy remains a common childhood neurological disorder in Nigeria, with a large burden of symptomatic epilepsy.

The outcome of childhood epilepsy: what improvements are needed?

epd.2013.0583 Auteur(s) : Peter Camfield1, Carol Camfield1, Willem F. Arts2, Oebele F. Brouwer3, Alexis Arzimanoglou4 1 Department of Pediatrics, Dalhousie University and the IWK Health Centre, University Ave, Halifax, Nova Scotia, Canada 2 Department of Paediatric Neurology, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands 3 Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands 4 Epilepsy, Sleep and Paediatric [...]

Course and outcome of childhood epilepsy: A 15-year follow-up of the Dutch Study of Epilepsy in Childhood

Course and outcome of childhood epilepsy: A 15-year follow-up of the Dutch Study of Epilepsy in Childhood

P02.1 10-year outcome of childhood epilepsy in well-functioning children and adolescents – social and psychological factors

P02.1 10-year outcome of childhood epilepsy in well-functioning children and adolescents – social and psychological factors

Course and outcome of childhood epilepsy: A 15‐year follow‐up of the Dutch Study of Epilepsy in Childhood

To study the course and outcome of childhood-onset epilepsy during 15-year follow-up (FU). We extended FU in 413 of 494 children with new-onset epilepsy recruited in a previously described prospective hospital-based study by questionnaire. Mean FU was 14.8 years (range 11.6-17.5 years). Five-year terminal remission (TR) was reached by 71% of the cohort. Course during FU was favorable in 50%, improving in 29%, and poor or deteriorating in 16%. Mean duration of seizure activity was 6.0 years (range 0-21.5 years), strongly depending on etiology and epilepsy type. Duration was <1 year in 25% of the cohort and exceeded 12 years in another 25%. Antiepileptic drugs (AEDs) were used by 86% during a mean of 7.4 years: one-third had their last seizure within 1 year of treatment, and one-third continued treatment at the end, although some had a 5-year TR. At last contact, 9% of the cohort was intractable. In multivariate analysis, predictors were nonidiopathic etiology, febrile seizures, no 3-month remission, and early intractability. Eighteen patients died; 17 had remote symptomatic etiology. Standardized mortality ratio for remote symptomatic etiology was 31.6 [95% confidence interval (CI) 18.4-50.6], versus 0.8 [95% CI 0.02-4.2] for idiopathic/cryptogenic etiology. In most children with newly diagnosed epilepsy, the long-term prognosis of epilepsy is favorable, and in particular, patients with idiopathic etiology will eventually reach remission. In contrast, epilepsy remains active in approximately 30% and becomes intractable in approximately 10%. AEDs probably do not influence epilepsy course; they merely suppress seizures. Mortality is significantly higher only in those with remote symptomatic etiology.

P042 Course and outcome of childhood epilepsy: a 15-year follow-up. Dutch study of epilepsy in childhood

P042 Course and outcome of childhood epilepsy: a 15-year follow-up. Dutch study of epilepsy in childhood

Determinants of outcome in childhood epilepsy

Possible outcomes with regard to seizures include remission (i.e. no seizures without drug treatment), conditional remission (i.e. no seizures under treatment) and treatment resistance. Several factors have been identified which are associated with favourable or unfavourable outcomes. These include syndrome diagnosis (benign vs severe epilepsy syndromes), seizure types (kind and number), severity of epilepsy, response to treatment (immediate vs delayed, monotherapy vs combinations), and concomitant neurological and psychiatric disorders. However, the quality of disease management by caretakers also has an important influence on the outcome. To determine full remission in patients who are seizure-free with treatment, antiepileptic drugs need to be tapered; generally speaking, this seems to be less risky in children than in adults. However, even if remission without treatment has been reached, an elevated risk of seizures may persist compared with that of the general population. The outcome of epilepsy should not be considered with respect to seizures alone, but should also include more global aspects of performance and quality of life. These may depend on the causes of epilepsy as much as, or more than, on the seizure disorder itself, but may also be related to treatment.

Factors Predictive of Outcome in Childhood Epilepsy

To identify early predictive factors of outcome in childhood epilepsy, the case records of all children with new-onset epilepsy presenting to a single neurology practice over a 10-year interval were reviewed. Only children with more than 2 years of follow-up were included. Cox regression analysis was used to identify factors predictive of remission (successful cessation of medication). One hundred ninety-six children (mean age 7.6 +/- 3.7 years at first seizure, mean follow-up 55 +/- 30 months) were identified. Ninety-eight of 196 children (50%) had an idiopathic epilepsy, 63 of 196 (32.1%) had cryptogenic epilepsy, and 35 of 196 (17.9%) had remote symptomatic epilepsy. At final assessment, 52.6% were in remission, 12.8% had a poor outcome (recurrent seizures on therapeutic antiepileptic drug levels within 6 months prior to the final assessment), and 6.9% were intractable (more than one seizure/month over 1 year with failure of three or more anticonvulsants). One year after initiating treatment, factors associated with a lower probability of remission included seizure recurrence in the 6- to 12-month interval after therapy initiation (hazard ratio 0.24), multiple seizure types (hazard ratio 0.40), and mental retardation at onset (hazard ratio 0.19). Factors predictive of a poor outcome included seizure recurrence in the 6- to 12-month interval after therapy initiation (odds ratio 21.6), more than one seizure type (odds ratio 8.9), and global developmental delay at onset (odds ratio 8.9). Factors predictive of intractability included multiple seizure types (hazard ratio 6.5), mental retardation at onset (hazard ratio 7.2), and seizure recurrence in the first 6 to 12 months of treatment (hazard ratio 70). It appears that response in the first 6 to 12 months on antiepileptic medication is predictive of outcome. Clinical features of the underlying epilepsy and concurrent neurologic conditions were independently associated with intractability and a lower probability of remission.

Constrictive pericarditis and hepatic encephalopathy

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Outcome of Childhood Epilepsy

Factors predictive of remission of epilepsy were evaluated in 504 patients followed for an average of 7 years at the Departments of Pediatrics and Mathematics, Dalhousie University and Children’s Hospital, Halifax, Nova Scotia, Canada.

Outcome of childhood epilepsy: A population-based study with a simple predictive scoring system for those treated with medication

A population-based study was conducted in an attempt to predict which child's epilepsy will remit. Use of data from a regional electroencephalography laboratory allowed identification of all children in Nova Scotia with epilepsy onset from 1977 through 1985 (excluding those with absence and "minor motor" seizures). Children were followed for an average of 7 years. On the basis of clinical characteristics, a multivariate analysis was used to develop a scoring scheme to predict remission (defined as off medication at the end of the follow-up period). Survival curve methods were used to estimate the duration of medication treatment for those with remission. Of the 504 eligible patients, approximately 70% became seizure free long enough to discontinue medication. Approximately 70% of those stopping medication a first time remained seizure free. At the end of follow-up, 55% of the total cohort were in remission. At diagnosis, the best predictors of remission were age < 12 years at onset, normal intelligence, no prior neonatal seizures, and fewer than 21 seizures before treatment. If predicted to have a remission, then, on the basis of survival curve analysis, 80% were without medication 100 months after diagnosis. After 12 months of treatment, prediction was enhanced by including a score for the number of seizures between 6 and 12 months on treatment. We conclude that approximately 55% of childhood epilepsy will remit. Our scoring system predicts reasonably accurately who will have a remission and when medication is likely to be discontinued.

Recent Advances in Treatment and Outcome of Childhood Epilepsy in Asia

Recent Advances in Treatment and Outcome of Childhood Epilepsy in Asia

Improvement of Modem Treatment and Outcome in Childhood Epilepsy in Asia

Epilepsy and epileptic syndromes are one of the major pediatric neurological diseases in Taiwan, R.O.C. In 1984 we investigated 38 elementary schools in Taichung city, in the middle-west part of Taiwan. Among 57,944 school-aged children, 388 had suffered from at least two episodes of afebrile seizures occurring separately over a two-week period. The period prevalence rate was 0.67%. In our clinic, once seizures are diagnosed, the seizure types are then classified as well as possible, in order to develop a rational approach to treatment. We commonly use carbamazepine for partial seizures and some generalized seizures, low dose ACTH (10 I.U.) for infantile spasms, valproic acid for absence seizures and myoclonic seizures, clonazepam for atonic-akinetic and myoclonic seizures, and phenobarbital for young children with generalized seizures. In the last three years, we have used a ketogenic diet for akinetic-atonic seizures and Lennox-Gastaut syndrome; we have also used temporal lobectomy for complex partial seizures since 1981. Owing to the marked increase in the medical understanding of epileptic seizures and syndromes, and models of treatment, there is no question that children with seizure disorders are better off today than they were ten years ago.

Perspectives of Mothers on Childhood Epilepsy in Kaduna, Northern Nigeria

Introduction: Epilepsy is one of the most common childhood neurological diseases and is associated with poor outcomes in developing countries where it is most prevalent. The epilepsy perspectives of adults in these countries have been found to influence epilepsy outcomes significantly. Assessing the epilepsy perspectives of mothers, who play a pivotal role in child care, is important to providing comprehensive epilepsy care and ensuring better outcomes. Objective: To assess the knowledge and attitude of mothers, as primary child care providers toward children with epilepsy. Materials and Methods: A structured questionnaire was administered to mothers attending a primary healthcare center, and it assessed their sociodemographic characteristics, knowledge and attitude with regards to childhood epilepsy. Knowledge was assessed based on responses to queries about etiology, manifestation, treatment and outcome of epilepsy in childhood. Attitude was assessed based on mothers' tendency toward stigmatization or discrimination against children with epilepsy. Results: A total of 523 mothers, whose age range was 17-52 years (mean 27.5 ΁ 10.3 years), was interviewed. Most were <30 years old (300, 57.4%), petty traders (217, 41.5%) and had a primary education (221, 42.3%). Spiritual cause (247, 47.2%) and falling to the ground (361, 69%) were the commonest epilepsy etiology and manifestation indicated respectively. Orthodox medical therapy (239, 45.7%), prayers (138, 30.2%) and traditional medication (118, 22.6%) were the main treatment modalities indicated. Most of the mothers (277, 53%) were uncertain about the outcome in childhood epilepsy. Stigmatization and discrimination against children with epilepsy were indicated by 120 (22.9%) and 481 (92%) of the mothers respectively. Lack of any formal education, indication of a spiritual etiology and perception of a poor outcome for epilepsy were significantly (P < 0.05) associated with the attitudinal disposition of the mothers. Conclusion: Majority of the mothers demonstrated appreciable deficiencies in their knowledge of epilepsy and had a negative attitudinal disposition toward epilepsy in childhood.