Uncomplicated Epilepsy Research Articles

Strong and weak points in the quality of life of school-age children with newly diagnosed uncomplicated epilepsy over the first six months: golden hours for prevention

Strong and weak points in the quality of life of school-age children with newly diagnosed uncomplicated epilepsy over the first six months: golden hours for prevention

Epilepsy in childhood and school performance: a nation-wide cohort study.

Childhood epilepsy has been linked to poor academic performance, but large-scale studies are lacking. In this nation-wide study of school-aged children, we examined the association between childhood epilepsy and school performance in standardized tests according to phenotypic and treatment-related characteristics. We performed a matched register-based cohort study of children born in Denmark (1997-2009) who participated in the Danish National School Test Programme between 2010 and 2019. We used population and health registers to identify children with epilepsy and a randomly sampled sex- and age-matched reference cohort without epilepsy (ratio 1:10). Norm-based test scores from language and mathematics reflecting performance as a percentile of the nation-wide distribution of scores (scale 1-100) were used to assess academic performance. Adjusted differences in mean standardized scores between children with and without epilepsy were estimated using linear regression models. Among 582 840 children participating in the School Test Programme, we identified 4659 (0.8%) children with epilepsy (52.8% males) and 46 590 matched reference children. Median age at epilepsy onset was 7.5 years (interquartile range: 4.0-10.6). Childhood epilepsy was associated with poorer school performance overall (mean score = 48.2 versus references = 56.7; adjusted difference = -6.7, 95% CI: -7.4 to -6.0), and worse performance was found in all epilepsy subgroups, including in 3534 children with uncomplicated epilepsy (i.e. no other pre-existing neurologic or intellectual disabilities and no identified possible cause for epilepsy; adjusted difference = -6.0, 95% CI: -6.8 to -5.2). No major variation by sex, age or subject was observed, but larger score differences were seen in children using antiseizure medication at time of testing (e.g. valproate monotherapy, adjusted difference = -9.3, 95% CI: -11.5 to -7.0 and lamotrigine monotherapy, adjusted difference = -13.1, 95% CI: -15.0 to -11.3) and in children with psychiatric comorbidity, especially epilepsy with comorbid intellectual disability (adjusted difference = -27.0, 95% CI: -30.0 to -23.9) and epilepsy with comorbid attention deficit/hyperactivity disorder (adjusted difference = -15.7, 95% CI: -19.0 to -12.4). Children with epilepsy scored significantly lower than their unaffected siblings (adjusted difference = -6.2, 95% CI: -7.1 to -5.4). In conclusion, childhood epilepsy was associated with impaired academic performance throughout schooling, which suggest that there is a widespread need for educational support of children with epilepsy, even when the child has no other comorbidities and when the epilepsy appears well-managed.

Differences in brain changes between adults with childhood-onset epilepsy and controls: A prospective population-based study.

PurposeTo determine the impact of childhood‐onset uncomplicated epilepsy (COE) on brain aging over 50‐year prospective follow‐up.MethodsA population‐based cohort of 41 aging subjects with COE and their 46 matched controls participated in a detailed in‐person prospective assessment in 2012 and 2017 to characterize ongoing changes in the aging brain.ResultsThe mean age of the COE participants was 63.2 years (SD 4.14, median 63.2, range 55.8–70.6) and 63.0 years (mean, SD 4.13, median 63.3, range 56.0–69.9) years for controls. Neurologic signs were significantly more common in COE participants not in remission (p = .015), and the most frequent abnormalities were cerebellar signs (p < .001). Neurologic signs in general (p = .008) and cerebellar signs in particular (p = .018) were significantly more common in focal than in generalized epilepsies. MRI white matter abnormalities were significantly associated with absence of vocational education (p = .011), and MRI hippocampal atrophy in COE subjects was associated with arterial hypertension versus normal blood pressure (p = .017). In the combined study cohort of COE subjects and controls, presenting neurologic signs increased both in the subjects and in the controls from the 2012 to 2017 study.ConclusionsAt ultra‐long‐term follow‐up, clinical and neuroimaging findings show tendencies to brain aging that is more accelerated in COE participants with active adult childhood‐onset epilepsy, and particularly in focal epilepsy.

Impaired responsibility dimension of self-esteem of Brazilian adolescents with epilepsy

This study aimed to compare the self-esteem of Brazilian adolescents with epilepsy and Brazilian adolescents without this condition and the correlations between self-esteem of these adolescents with depression and anxiety symptoms. Study participants were 101 adolescents of both sexes, aged 10-19years old, from elementary and high school education. Fifty patients diagnosed with uncomplicated epilepsy attending the pediatric epilepsy clinic of University Hospital composed the case group. The other fifty-one adolescents without this diagnosis were attending public schools in Campinas-SP region. The instruments used were: identification card with demographics and epilepsy data, Multidimensional Self-Esteem Scale, Beck Depression Inventory and Inventory of State-Trait Anxiety - IDATE. A statistically significant result was found in the Responsibility Self-esteem Dimension favoring the control group. Significant correlations between self-esteem scores and anxiety and depression symptoms were also found. The development of a chronic disease such as epilepsy leads to a change in the way the individual perceives himself and the social environment he is inserted, influencing his behavior. The way people with epilepsy experience their seizures is a subjective measure that will control his/her well-being. Childhood and adolescence form the basis for a healthy emotional development; thus, our results show the importance of studying how subjective variables relate to the physical aspects of a chronic disease in these life stages.

Social outcomes of young adults with childhood-onset epilepsy: A case-sibling-control study.

We aimed to compare long-term social outcomes in young adults with childhood-onset epilepsy (cases) with neurologically normal sibling controls. Long-term social outcomes were assessed at the 15-year follow-up of the Connecticut Study of Epilepsy, a community-based prospective cohort study of children with newly diagnosed epilepsy. Young adults with childhood-onset epilepsy with complicated (abnormal neurologic exam findings, abnormal brain imaging with lesion referable to epilepsy, intellectual disability (ID; IQ < 60) or informative history of neurologic insults to which the occurrence of epilepsy might be attributed), and uncomplicated epilepsy presentations were compared to healthy sibling controls. Age, gender, and matched-pair adjusted generalized linear models stratified by complicated epilepsy and 5-year seizure-free status estimated adjusted odds ratios (aORs) and 95% confidence intervals [CIs] for each outcome. The 15-year follow-up included 361 individuals with epilepsy (59% of initial cases; N = 291 uncomplicated and N = 70 complicated epilepsy; mean age 22 years [standard deviation, SD 3.5]; mean epilepsy onset 6.2 years [SD 3.9]) and 173 controls. Social outcomes for cases with uncomplicated epilepsy with ≥5 years terminal remission were comparable to controls; cases with uncomplicated epilepsy <5 years seizure-free were more likely to be less productive (school/employment < 20 h/week) (aOR 3.63, 95% CI 1.83-7.20) and not to have a driver's license (aOR 6.25, 95% CI 2.85-13.72). Complicated cases with epilepsy <5 years seizure-free had worse outcomes across multiple domains; including not graduating high school (aOR 24.97, 95% CI 7.49-83.30), being un- or underemployed (<20 h/week) (aOR 11.06, 95% CI 4.44-27.57), being less productively engaged (aOR 15.71, 95% CI 6.88-35.88), and not living independently (aOR 10.24, 95% CI 3.98-26.36). Complicated cases without ID (N = 36) had worse outcomes with respect to productive engagement (aOR 6.02; 95% CI 2.48-14.58) compared to controls. Cases with complicated epilepsy were less likely to be driving compared to controls, irrespective of remission status or ID. In individuals with uncomplicated childhood-onset epilepsy presentations and 5-year terminal remission, young adult social outcomes are comparable to those of sibling controls. Complicated epilepsy, notable for intellectual disability, and seizure remission status are important prognostic indicators for long-term young adult social outcomes in childhood-onset epilepsy.

Determinants of Social Outcomes in Adults With Childhood-onset Epilepsy.

Adults with childhood-onset epilepsy experience poorer adult social outcomes than their peers. The relative roles of seizures over time versus learning and psychiatric problems are unclear. We examined independent influences of psychiatric and learning disorders and of seizure course in 241 young adults (22-35 years old) with uncomplicated epilepsy in a longitudinal community-based cohort study. Social outcomes were ascertained throughout the study. A history of psychiatric and learning problems was ascertained ∼9 years after study entry. Seizure course was: "Excellent," no seizures after the first year, in complete remission at last contact (N = 95, 39%); "Good," seizures occurred 1 to 5 years after diagnosis, in complete remission at last contact (N = 56, 23%); "Fluctuating," more complicated trajectories, but never pharmacoresistant (N = 70, 29%); "Pharmacoresistant," long-term pharmacoresistant (N = 20, 8%). Multiple logistic regression was used to identify contributors to each social outcome. Better seizure course predicted college completion, being either employed or pursuing a degree, and driving, but was not substantially associated with other social outcomes. Poorer seizure course was associated with a greater likelihood of having offspring, particularly in women without partners. Learning problems, psychiatric disorders, or both negatively influenced all but 2 of the social outcomes. In young adults with uncomplicated epilepsy, the course of seizures contributed primarily to education, employment, and driving. A history of learning problems and psychiatric disorders adversely influenced most adult outcomes. These findings identify potential reasons for vocational and social difficulties encountered by young adults with childhood epilepsy and areas to target for counseling and transition planning.

Self-concept in children and adolescents with epilepsy: The role of family functioning, mothers’ emotional symptoms and ADHD

PurposeThis study aimed to identify the associated factors of poor self-concept in children and adolescents with epilepsy. MethodsFifty-three patients with uncomplicated epilepsy (aged 7–18years) and 28 healthy controls were included. Study measures included the Piers-Harris 2 Self-Concept Scale, Family Assessment Device (FAD), Turgay DSM-IV based ADHD rating Scale (T-DSM-IV-S), Conners’ Teacher Rating Scale (CTRS-R), Beck Depression Inventory and State–Trait Anxiety Inventory (STAI). Neurology clinic charts were reviewed for the epilepsy-related variables. ResultsWhile the Piers-Harris 2 total score was not significantly different between the groups, patients with epilepsy had lower (poorer) scores on freedom from anxiety and popularity subscales. Linear regression analysis revealed that the problem solving, affective responsiveness, general functioning and communication scores of FAD; total and inattentiveness scores of T-DSM-IV-S and mothers’ Beck scores were associated with the total score of Piers-Harris 2. Epilepsy-related factors were not found to be associated with self-concept scores. ConclusionPoor self-concept in children with epilepsy is associated with negative family functioning, mothers’ emotional symptoms and ADHD, especially the symptoms of inattentiveness.

Mental health problems in children with uncomplicated epilepsy; relation with parental anxiety.

Mental health problems and parental anxiety in children with epilepsy were investigated. Parents of 83 children with epilepsy and 172 healthy children were asked to complete Strengths and Difficulties Questionnaire for their children and State-Trait Anxiety Inventory for themselves. In those with epilepsy, 39.8% (n: 33) were girls, 60.2% (n: 50) were boys and their mean age was 9.34 ± 3.99 years. Control group was more successful in school (p < 0.001). Emotional problems score in children with epilepsy was higher than control group (p < 0.001). Case group's behavior problems and attention deficit hyperactivity scores were higher (p < 0.001, p=0.009 respectively). Prosocial behavior scores of the control group were significantly higher (p=0.004). State (p=0.001) and trait (p=0.001) anxiety levels of parents of children with epilepsy were higher. Children with epilepsy have more neuro-behavioral problems; and their parents have greater anxiety levels. Physicians should be in contact with children with epilepsy for the psychological health of the family besides seizure control.

Childhood-onset epilepsy five decades later. A prospective population-based cohort study.

To study the impact of childhood-onset epilepsy on a variety of outcomes across the life span. A population-based cohort of 245 subjects with childhood-onset epilepsy was assessed for outcomes at 45 years. In addition, 51 of 78 surviving subjects with uncomplicated epilepsy and 52 of 99 originally matched controls participated in a detailed evaluation including electroencephalography (EEG), imaging, and laboratory studies at 50 years. Of 179 surviving subjects, 61% were in terminal 10-year remission and 43% in remission off medications. At 45 years, 95% of the idiopathic group, 72% of the cryptogenic group, and 47% of the remote symptomatic group were in terminal remission (p < 0.001). Abnormal neurologic signs were significantly more common in subjects with uncomplicated epilepsy than in controls. Mortality during period 1992-2012 was higher in subjects than in controls (9% vs. 1%, p = 0.02). The rate of 3T MRI abnormalities was higher in subjects than in controls (risk ratio [RR] 2.0; 1.3-3.1) specifically including findings considered markers of cerebrovascular disease (RR 2.5; 1.04-5.9). Even subjects with idiopathic epilepsy had higher rates of imaging abnormalities than controls (73% vs. 34%, p = 0.002). Long-term seizure outcomes are excellent and a function of etiology. The presence of imaging abnormalities suggestive of vascular disease may put these subjects at higher risk for clinically evident stroke and cognitive changes as they age.

General health concerns for children with epilepsy

Epilepsy is defined by the International League Against Epilepsy as a chronic neurological condition characterized by recurrent epileptic seizures. Most physicians who participate in the care of children are aware that epilepsy is one of the most common chronic disorders that affect children. Epilepsy is prevalent in every country, in every race and religion and in every socioeconomic status. There are of course founder effects for particular epilepsies in certain populations, but aside from these considerations the distribution of the epilepsies is remarkably similar across the planet. Epilepsy can begin at any age, although there are two more frequent ages of onset: in early childhood, reflecting hypoxic-ischemic encephalopathy, inborn errors of metabolism, genetic epilepsies and brain malformations, and in adolescence, reflecting for the most part age related genetic epilepsies. When a child with epilepsy presents for the first time to the clinic or to the emergency room, the presenting complaint is not usually of epilepsy but rather of staring spell, inattentiveness or loss of consciousness. It is the pediatric neurologist’s work to determine whether a particular child does in fact have epilepsy, or instead has convulsive syncope, breath-holding spells, myoclonus (either pathologic or of the benign nocturnal variety), chorea, dystonia, micro-sleeps, is inattentive or is enjoying the delights of day-dreaming. As with any disorder, taking a complete history is most important in determining what type of paroxysmal event occurred. Tests including electroencephalography andmagnetic resonance imaging are used to refine and confirm the clinical impression. Children with uncomplicated epilepsy are often returned to the care of their pediatricians, family physicians or pediatric nurse practitioners after diagnosis, although some continue to be cared for by a pediatric neurologist. When epilepsy is refractory, then referral to a pediatric epileptologist in an epilepsy center is warranted. When a child is diagnosed with epilepsy, his or her pediatric neurologist is careful to clearly explain the diagnosis and the principles of seizure management, the choices of anticonvulsant medications to be considered and their risks, benefits and side effects, seizure first aid, seizure precautions, lifestyle modifications and activities to avoid. Introductions to the clinic nurse and social worker are made. The primary health care provider receives an initial communication, and clinic contact information for questions or issues that arise between visits is provided to the family. All of these discussions and activities are extremely important, and yet there remains a large swath of a child’s life that is also affected by the diagnosis of epilepsy, either directly or indirectly. What of the child’s education, the after school activities, the effects on other medical conditions that a child may have, the general medical care of the child and the effects on the family as a whole? These issues are not usually highlighted in the education of a pediatric neurologist, and so this issue devoted to general health concerns for children with epilepsy has been prepared. I hope that you find the thoughtful discussions as interesting and as informative as I have. *Address for correspondence: Carol Macmillan, Department of Pediatrics, University of Chicago, 5841 South Maryland MC 3055, Chicago, IL 60637-1470, USA. Tel.: +1 773 702 6487; Fax: +1 773 702 4786; E-mail: cmacmill@peds.bsd.uchicago.edu. Journal of Pediatric Epilepsy 2 (2013) 145 DOI 10.3233/PEP-13055 IOS Press 145

Quality of life and sense of coherence in young people and adults with uncomplicated epilepsy: A longitudinal study

ObjectivesThe aim of the study was, in a ten-year follow-up, to describe and explore potential changes in quality of life and sense of coherence in relation to gender differences among persons with epilepsy in the transition from adolescence to adulthood. Materials and methodsA longitudinal study of sense of coherence (SOC) and quality of life with repeated measurement design (1999, 2004, and 2009) was conducted in a population of persons (n=69) who were aged 13–22years in 1999 and 23–33years in 2009. The Quality-of-Life Index (QLI) and the Sense of Coherence (SOC) scale were used. ResultsThere was a significant decrease (p≤0.001) in seizures compared with the 2004 results, mainly among the women (p=0.003). When comparing the total QLI scores, no significant differences were found between the three data collections and there were no differences in total scores between men and women. There was a decrease in the SOC total score over the 10-year period study. Total SOC was significantly higher among those being 30–33years old compared to those being 23–29years old (p=0.014) and among those having a driving license (p=0.029) compared to those not having a driving license. ConclusionsBoth quality of life and sense of coherence are important for maintaining health and well-being. Promoting health and well-being requires effective high-quality multidisciplinary person-centered care.

Brief clinical screening for academic underachievement in new-onset childhood epilepsy: Utility and longitudinal results

ObjectiveThis study was conducted to determine the lifetime rate and distribution of supportive academic and educational services provided to children with new- or recent-onset epilepsy and typically developing controls, the relationship of this history to objective academic test performance, and the course of performance over serial evaluations (baseline and 2 and 5years later). MethodsResearch participants were 91 children aged 8–18 at study entry, including 50 youth with recent-onset epilepsy (28 focal [FE] and 22 generalized [GE] epilepsy) and healthy first-degree cousin controls (n=41). The sample with epilepsy included children with uncomplicated epilepsy and normal imaging and development. Lifetime history of a diversity of supportive educational services was determined via a structured interview with parents at the baseline study visit. Associations were examined between these support services and participants' academic performance in reading, spelling, and arithmetic (Wide Range Achievement Test—Revision 3 [WRAT3] [12]) during three serial study visits including baseline and 2 and 5years later. ResultsChildren with epilepsy had a higher lifetime rate of provision of diverse academic supportive services compared to controls at the baseline visit (52% vs. 18%). These services antedated epilepsy diagnosis in the majority (80.8%) of the children with epilepsy. Among children with epilepsy, children who presented with academic services had significantly lower WRAT3 reading, spelling, and arithmetic performance at baseline and at 2- and 5-year follow-ups. ConclusionA brief structured clinical interview conducted with parents identifies children with epilepsy who are at academic risk at the time of diagnosis, with that risk persisting up to 5years later.

A 3 year audit of adult epilepsy care in a Nigerian tertiary hospital (2011-2013).

Epilepsy audit provides positive feedback to physicians that could assist in improving the quality of health care services provided for patients. This study was carried out to evaluate care given to people with epilepsy with the aim of determining potentials for improvement. Medical records of patients with uncomplicated epilepsy who have attended the neurology clinic at the University of Ilorin Teaching Hospital for not less 12 months between years 2011and 2013 were reviewed. A total of 125 patients were as evaluated; of which 64 (51%) were males and 61 (49%) were females. Their median age was 26 (21-40) years and median seizure duration of 9 (4-15) years. Close to 65% of the patients were below 30 years of age. Most patients (68%) were referred by general practitioners/family physicians. Generalized epilepsy was the predominant seizure type seen in 73 (58%) patients. Majority of patients (76%) were on antiepileptic drug (AED) monotherapy, and 28 (22%) were on two AEDs combination. Eighty-one patients (64%) used carbamazepine either singly (63%) or in combination (18%) at an average dose of 600 mg/day. The two other common AEDs used were: Sodium valproate (45%) and phenobarbitone (9%). Fifty-one patients (41%) had good seizure control (no seizure in preceding 1 year), 34 (27%) had partial control (<12 attacks/year) and 41 (36%) had poor control (>1 attack/month). Overall, 66 patients (48%) had their medication changed between 2 and 3 times in the course of treatment, and the most common reason was poor seizure control. Twenty-one (21%) did not comply with the use of given AED. Less than half of our patients had good epilepsy control. To improve on drug compliance attending physicians need to prescribe more of the relatively cheaper AED like the phenobarbitone and to optimize drug dosage before switching to another.

Complete remission of childhood-onset epilepsy: stability and prediction over two decades.

The ultimate seizure outcome of childhood epilepsy is complete resolution of all seizures without further treatment. How often this happens and how well it can be predicted early in the course of epilepsy could be valuable in helping families understand the nature of childhood epilepsy and what to expect over time. In the Connecticut study of epilepsy, a prospective cohort of 613 children with newly-diagnosed epilepsy (onset age 0-15 years), complete remission, ≥5 years both seizure-free and medication-free, was examined as a proxy of complete seizure resolution. Predictors at initial diagnosis were tested. Information about seizure outcomes within 2 years and from 2-5 years after diagnosis was sequentially added in a proportional hazards model. The predictive value of the models was determined with logistic regression. Five hundred and sixteen subjects were followed ≥10 years. Three hundred and twenty-eight (63%) achieved complete remission; 23 relapsed. The relapse rate was 8.2 per 1000 person-years and decreased over time: 10.7, 6.7, and 0 during first 5 years, the next 5 years, and then >10 years after complete remission (P=0.06 for trend). Six participants regained complete remission; 311 (60%) were in complete remission at last contact. Baseline factors predicting against complete remission at last contact included onset age≥10 years (hazard ratio=0.55, P=0.0009) and early school or developmental problems (hazard ratio=0.74, P=0.01). Factors predicting for complete remission were uncomplicated epilepsy presentation (hazard ratio=2.23, P<0.0001), focal self-limited epilepsy syndrome (hazard ratio=2.13, P<0.0001), and uncharacterized epilepsy (hazard ratio=1.61, P=0.04). Remission (hazard ratio=1.95, P<0.0001) and pharmaco-resistance (hazard ratio=0.33, P<0.0001) by 2 years respectfully predicted in favour and against complete remission. From 2 to 5 years after diagnosis, relapse (hazard ratio=0.21, P<0.0001) and late pharmaco-resistance (hazard ratio=0.21, P=0.008) decreased and late remission (hazard ratio=2.40, P<0.0001) increased chances of entering complete remission. The overall accuracy of the models increased from 72% (baseline information only), to 77% and 85% with addition of 2-year and 5-year outcomes. Relapses after complete remission are rare making this an acceptable proxy for complete seizure resolution. Complete remission after nearly 20 years is reasonably well predicted within 5 years of initial diagnosis.

Cognition, academic achievement, and epilepsy in school-age children: A case–control study in a developing country

We conducted a case–control study of 33 Jamaican children 7 to 12years old with uncomplicated epilepsy and 33 of their classroom peers matched for age and gender to determine whether epilepsy resulted in differences in cognitive ability and school achievement and if socioeconomic status or the environment had a moderating effect on any differences. Intelligence, language, memory, attention, executive function, and mathematics ability were assessed using selected tests from NEPSY, WISCR, TeaCh, WRAT3 — expanded, and Raven's Coloured Progressive Matrices. The child's environment at home was measured using the Middle Childhood HOME inventory. Socioeconomic status was determined from a combination of household, crowding, possessions, and sanitation. We compared the characteristics of the cases and controls and used random effects regression models (using the matched pair as the cluster) to examine the relationship between cognition and epilepsy. We found that there was no significant difference in IQ, but children with epilepsy had lower scores on tests of memory (p<0.05), language (p<0.05), and attention (p<0.01) compared with their controls. In random effects models, epilepsy status had a significant effect on memory (coefficient=−0.14, CI: −0.23, −0.05), language (coefficient=−0.13, CI: −0.23, −0.04), and mathematics ability (coefficient=−0.01, CI: −0.02, −0.00). Adjustment for the home environment and socioeconomic status and inclusion of interaction terms for these variables did not alter these effects. In conclusion, we found that epilepsy status in Jamaican children has a significant effect on performance on tests of memory, language, and mathematics and that this effect is not modified or explained by socioeconomic status or the child's home environment.

Cardiac troponin I (CTnI) level among children with epileptic seizures

Abstract Epilepsy is a common chronic neurological disorder in pediatric age characterized by recurrent, unprovoked seizures; these seizures are transient signs of abnormal excessive or hyper synchronous neuronal activity in the brain. Complicated epilepsy is associated with high seizure frequency, prolonged seizures and may lead to some sort of cardiac ischemia, myocardial injury and elevated serum CTnI. Aim A possible importance of Cardiac troponin I (CTnI) level in epileptic children. Patients and methods The study was carried out upon 90 children, classified into three groups: Group I: 30 with uncomplicated epilepsy. Group II: 30 with complicated epilepsy. Group III (control): 30 apparently clinically healthy children with similar age and sex. All groups were subjected to the following: full history taking – thorough clinical examination – EEG – assessment of serum cardiac troponin I- and CT only for groups I and II. Results Our research revealed a significant statistical increase in the cardiac troponin level (CTnI) maximum in group II followed by group I then lastly group III and revealed a direct correlation between cardiac troponin I and presence of prenatal problem, mental retardation, EEG abnormality and abnormal C T or MRI. There was an indirect correlation between cardiac troponin I and age of seizure onset. Also there was one between cardiac troponin I and etiology of epilepsy. Conclusion Cardiac troponin I is a perfect tool for early detection of cases with myocardial dysfunction in epileptic patients – cardiac troponin I is significantly increased in children with epilepsy especially the complicated epilepsy. Cardiac injury in epileptic children is more common in patients with early onset epilepsy, positive prenatal problem, idiopathic epilepsy, abnormal imaging and EEG – elevated TnI levels may be of value in assessing the severity and eventual outcome and mortality risk of the disease in children with epilepsy.

Injuries in Adolescents with Childhood-Onset Epilepsy Compared with Sibling Controls

To compare the occurrence of injuries in adolescents with childhood-onset epilepsy and matched sibling controls. Retrospective case-control lifetime injury assessments were obtained from a community-based cohort of adolescents with childhood-onset epilepsy diagnosed 9 years earlier and their siblings. The children with epilepsy (n = 501; mean age, 15.3 years) included those with complicated (abnormal neurologic examination or IQ <80; n = 133) and uncomplicated (normal neurologic examination and IQ ≥80; n = 368) epilepsy. Children with uncomplicated epilepsy were matched to sibling controls (n = 210 pairs). The children reported whether or not they had ever (before and after epilepsy diagnosis) experienced injuries "serious enough to require medical attention" and if so, the type of treatment required. Almost one-half (49.1%) of the children with epilepsy experienced injury, of whom 8.9% required surgery/hospitalization and 17.1% had injury related to a seizure. Fewer children with uncomplicated epilepsy had seizure-related injuries versus those with complicated epilepsy (13.6% vs 27.4%; P ≤ .01). The proportion of children with epilepsy with any injury by type (not mutually exclusive) were: 25.2% with fractures (n = 126); 24.4% with head injuries (n = 122); 10.2% with other injuries (n = 51); 8.4% with dental injuries (n = 42); and 8% with burns/scalds (n = 40). A similar proportion of children with uncomplicated epilepsy experienced any injury (overall and by type) compared to matched sibling controls, with the exception that more children with uncomplicated epilepsy had head injuries (30.0% vs 19.5%; P < .02). With the exception of head injuries, we found no evidence of an increased risk of injury in a representative cohort of children with epilepsy compared with matched sibling controls. This finding may reflect the fact that the sample was not biased to more severe cases, or that safety precautions to prevent injury were widely used.

Mortality Risks in New-Onset Childhood Epilepsy

Estimate the causes and risk of death, specifically seizure related, in children followed from onset of epilepsy and to contrast the risk of seizure-related death with other common causes of death in the population. Mortality experiences from 4 pediatric cohorts of newly diagnosed patients were combined. Causes of death were classified as seizure related (including sudden unexpected death [SUDEP]), natural causes, nonnatural causes, and unknown. Of 2239 subjects followed up for >30 000 person-years, 79 died. Ten subjects with lethal neurometabolic conditions were ultimately excluded. The overall death rate (per 100 000 person-years) was 228; 743 in complicated epilepsy (with associated neurodisability or underlying brain condition) and 36 in uncomplicated epilepsy. Thirteen deaths were seizure-related (10 SUDEP, 3 other), accounting for 19% of all deaths. Seizure-related death rates were 43 overall, 122 for complicated epilepsy, and 14 for uncomplicated epilepsy. Death rates from other natural causes were 159, 561, and 9, respectively. Of 48 deaths from other natural causes, 37 were due to pneumonia or other respiratory complications. Most excess death in young people with epilepsy is not seizure-related. Mortality is significantly higher compared with the general population in children with complicated epilepsy but not uncomplicated epilepsy. The SUDEP rate was similar to or higher than sudden infant death syndrome rates. In uncomplicated epilepsy, sudden and seizure-related death rates were similar to or higher than rates for other common causes of death in young people (eg, accidents, suicides, homicides). Relating the risk of death in epilepsy to familiar risks may facilitate discussions of seizure-related mortality with patients and families.

Injuries amongst Adolescents with Childhood-Onset Epilepsy Compared to Sibling Controls (S06.004)

Objective: To assess retrospective reports of injuries among a population-based cohort of adolescents diagnosed with epilepsy nine years earlier, and compare to that of sibling controls. Background Persons with refractory epilepsy are at increased risk for injuries, but occurrence amongst a representative cohort of children with epilepsy (CWE) including uncomplicated epilepsy (CWUE) at long-term follow-up is unknown. Design/Methods: In a prospective, community-based study of newly diagnosed childhood-onset epilepsy, CWE (n=501) and sibling controls reported whether they had EVER (includes before and after epilepsy diagnosis) experienced certain types of injuries “serious enough to require medical attention,” at 9-year follow-up. Injury rates amongst CWUE (normal neurological exam and IQ≥80) were compared with matched sibling controls (n=210 pairs). Results: Mean age of epilepsy onset was 5.8 years; 49.7% were female. At follow-up, CWE (n=501) were 15.3 years old; 56.9% were ≥5-years seizure-free, 37.5% were taking ≥1 anti-epileptic drug, 76.5% had an IQ≥80 and 87.6% had a normal neurological exam. 49.1% of CWE experienced any injury, of whom 9.3% required surgery/hospitalization and 17.1% had an injury due to a seizure; CWUE (n=368) had lower rates of injury due to a seizure versus those with complicated epilepsy (n=133) (13.6% vs. 27.4%; p≤0.01). Rates of any injury by type (not mutually exclusive) amongst all CWE were: 8% burns/scalds, 25.2% fractures, 24.4% head, 8.4% dental and 10.2% other. CWUE and matched controls (n=210) had a similar rate of any injury (overall and by type) except CWUE had a higher rate of any head injury (30.0% vs. 19.5%; p Conclusions: While nearly half of CWE report ever having an injury requiring medical attention, the rate of injuries amongst CWUE was comparable to that of matched sibling controls, except for having more head injuries. The majority of CWE did not require hospitalization/surgery nor experienced the injury due to a seizure. Supported by: NINDS-R37-NS31146 (PI-Berg). Disclosure: Dr. Baca has nothing to disclose. Dr. Vickrey has received personal compensation for activities with EMD Serono. Dr. Vassar has nothing to disclose. Dr. Cook has nothing to disclose. Dr. Berg has received personal compensation for activities with BIAL as a speaker.

Clinical characteristics and use of antiepileptic drugs among adolescents with uncomplicated epilepsy at a referral center in Novi Sad, Serbia

The study aimed to investigate the type and etiology of epileptic seizures and the use of antiepileptic drugs for the treatment of various forms of epileptic seizures among adolescents with active but uncomplicated epilepsy at a tertiary referral center in Novi Sad, Serbia. The study design was cross sectional. Data were obtained from patients and medical records. A total of 103 adolescents (39 males and 64 females) with active but uncomplicated epilepsy were included. Patients with primary generalized seizures had significantly better control of epilepsy than those with partial seizures with or without secondary generalization. A total of 80 (77.7%) adolescents had no known underlying etiology based on initial diagnosis and evaluation. All adolescents were classified into known idiopathic syndromes (54.4%), non-classifiable cryptogenic etiology (23.3%), and secondary epilepsy attributed to MRI-identified lesions (22.3%). Eighty-eight percent of adolescents were taking monotherapy and 64.8% of these were taking valproate. New antiepileptic drugs (AEDs), topiramate and lamotrigine, the only drugs available free of charge at the Serbian market, were used in 19.4% of patients. A total of 57.3% adolescents were seizure-free, 24.2% had occasional seizures, and 18.5% had seizures despite AED treatment.