Clinical course and seizure outcome of idiopathic childhood epilepsy: determinants of early and long-term prognosis

Abstract

BackgroundIdiopathic epilepsies and epileptic syndromes predominate childhood and adolescence epilepsy. The aim of the present study was to investigate the clinical course and outcome of idiopathic childhood epilepsy and identify variables determining both early and long-term prognosis.MethodsWe followed 303 children with newly diagnosed idiopathic epilepsy aged 1–14 years old, both prospectively and retrospectively. Outcome was defined at one, 2 and 4 years of follow-up, as well as at the end of the study period for all patients. Based on the data collected, patients were classified in four patterns of clinical course: “excellent”, “improving”, “relapsing” and “poor”. Variables defined at intake and after the initial year of treatment were analyzed for their prognostic relevance towards the clinical course and outcome of the patients.ResultsThe mean age at seizure onset was 6,7 years and the mean duration of follow-up was 8,3 years (range 2,0-22,0,SD 4,24). During the initial year of treatment, 70,3% of patients were seizure-free. The course of epilepsy was “excellent” in 53,1% of the subjects, “improving” in 22,8%, “relapsing” in 22,1% whereas only 6 children with idiopathic epilepsy (2%) had a “poor” clinical course exhibiting drug-resistance. After multivariate analysis, variables predictive of a poor initial response to therapy were early seizure onset, multiple seizure types and history of status epilepticus. At the end of follow-up, early response to treatment was of significant positive predictive value, while the presence of multiple seizure types and the history of migraine had a negative impact on prognosis.ConclusionsIn the vast majority of children, the long-term prognosis of idiopathic epilepsy is favorable. More than half of the patients attain seizure freedom immediately and their clinical course is considered “excellent”. About one fifth exhibit either an improving or a fluctuating course. Early seizure onset, multiple seizure types and status epilepticus are predictive of an initial poor response to treatment in children with idiopathic epilepsy. Initial non-response to treatment, multiple seizure types and history of migraine are determinants of a less favorable final outcome after long-term follow-up.

Glucose Metabolic Profile by Visual Assessment Combined with Statistical Parametric Mapping Analysis in Pediatric Patients with Epilepsy

“…We retrospectively reviewed 142 pediatric epilepsy patients who had undergone 18 F-FDG PET, EEG, and MRI examinations to detect epileptogenic areas. The inclusion criteria were as follows: clinical diagnosis of epilepsy (14); age between 7 and 14 y; detailed information of EEG and MRI; the last seizure occurring more than 24 h before 18 F-FDG PET study (15); and completion of 12-mo clinical follow-up after 18 F-FDG PET imaging.…”

“…The highest clinical benefit of 18 F-FDG PET can be achieved in patients with MRI-negative TLE, for whom 18 F-FDG PET correctly lateralized the lesion in 80% of the cases (13). However, for the nonsurgical patients, especially for the nonsurgical pediatric children, the clinical diagnostic and prognostic values of 18 F-FDG PET remain unclear.…”

“…Therefore, we hypothesized that visual assessment combined with statistical parametric mapping (SPM) analysis (or SPM-based visual analysis) of 18 F-FDG PET images could be useful for evaluating the correlation between cerebral metabolism and clinical severity or progress in epilepsy patients. The aim of this study was to evaluate the glucose metabolic profile using 18 F-FDG PET/CT imaging in patients with nonsurgical epilepsy.…”

“…The aim of this study was to evaluate the glucose metabolic profile using 18 F-FDG PET/CT imaging in patients with nonsurgical epilepsy.…”

“…Recently, interictal PET with 18 F-FDG has been used as a powerful neuroimaging technology for presurgical evaluation of epileptogenic foci (7)(8)(9) and has demonstrated a sensitivity of 70%-90% in TLE and 33%-67% in extra-TLE patients, depending on the localization of the focus (10)(11)(12). The highest clinical benefit of 18 F-FDG PET can be achieved in patients with MRI-negative TLE, for whom 18 F-FDG PET correctly lateralized the lesion in 80% of the cases (13).…”