Long‐Term Prognosis in Childhood Epilepsy: Survival and Seizure Prognosis

Brorson, Lars-Olov; Wranne, L

doi:10.1111/j.1528-1157.1987.tb03651.x

Cited by 210 publications

(149 citation statements)

References 6 publications

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“…In children, this occurs primarily in patients with secondary epilepsy (1-5). The increased mortality is also partly the result of associated disorders, because the mortality rate in children with epilepsy without neurologic deficits did not differ from that in the normal population, in contrast to the increased rate in children with neurologic deficits such as mental retardation and cerebral palsy (5). All 21 patients who died in our study had delayed development.…”

Section: Discussionmentioning

confidence: 52%

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Incidence of Death in Patients with Intractable Epilepsy During Nitrazepam Treatment

et al. 1999

Epilepsia

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Summary:Purpose: Increased risk of death has been reported in patients with intractable epilepsy (IE) taking nitrazepam (NZP).Methods: Between January 1983 and March 1994, 302 patients with IE were entered into a NZP compassionate-plea protocol. NZP was discontinued if there was 4 0 % seizure reduction or significant side effects. In some patients with >SO% reduction, it also was discontinued for lack of sufficient effect. At the end of follow-up for this study, 62 patients remained taking NZP. Patients took NZP from 3 days to 10 years.Results: Twenty-one of 302 patients died after institution of NZP. Fourteen of 2 1 of these were taking NZP at death, and in five of 2 1, the NZP had been discontinued. Two patients were excluded from analysis, because it is unclear whether NZP had been discontinued before death. Six other patients were lost from follow-up. Of the 14 deaths with NZP, seven were sudden, six were of pneumonia, and one was of cystinosis. Nine had at least one contributing factor, such as dysphagia, gastroesophageal reflux, or recurrent aspirations. The 294 patients took NZP for a total of 704 patient years (ptyrs), and were discontinued for a total of 856 ptyrs. There were I .98 deaths/ 100 ptyrs on NZP compared with 0.58 deaths/[ 00 ptyrs without NZP, most of the former being associated with side effects of NZP. Mortality in patients younger than 3.4 years was 3.98 with NZP compared with 0.26 deathdl00 ptyrs without NZP (p = 0.0002). Corresponding figures in patients 3.4 years or older were 0.50 and 0.86 deathdl00 ptyrs, respectively.Conclusions: NZP therapy for epilepsy apparently increases the risk of death, especially in young patients with IE. This should be considered in antiepileptic drug (AED) management decisions.

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Section: Discussionmentioning

confidence: 52%

“…At the time of death, none of our patients had unusually high concentrations of these two or other AEDs. In the NZP group, six patients (4, 5,6,8,9,13) were taking VPA. None of these children had abnormal blood tests associated with VPA or serious side effects.…”

Section: Aeds and Deathmentioning

confidence: 99%

Incidence of Death in Patients with Intractable Epilepsy During Nitrazepam Treatment

et al. 1999

Epilepsia

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“…These neurodevelopmental predictors are comparable to similar findings both in developed and resource-poor countries. 24 Associations between low IQ and poor seizure control have been found in several studies, [25][26][27][28][29] as has motor disability. 2,25-39 A significant predictor in this study was multiple types of seizure, a relatively unreported finding.…”

Section: Discussionmentioning

confidence: 99%

“…24 Associations between low IQ and poor seizure control have been found in several studies, [25][26][27][28][29] as has motor disability. 2,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] A significant predictor in this study was multiple types of seizure, a relatively unreported finding. 2,38 It is possible that the average delay of 15 months from seizure onset to assessment allowed time for other seizure types to appear.…”

Section: Discussionmentioning

confidence: 99%

Prediction of seizure outcome in childhood epilepsies in countries with limited resources: a prospective study

Banu

Khan

Hossain

et al. 2012

Develop Med Child Neuro

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AIM To identify predictors of seizure control in newly presenting children with epilepsy in countries with limited resources.METHOD Three hundred and ninety children (273 males, 117 females) aged 2 months to 15 years with newly diagnosed epilepsy were enrolled prospectively at first visit to the multidisciplinary clinic at the children's hospital in Dhaka, Bangladesh. Data about seizures, motor disability, psychomotor development, and electroencephalography were obtained. Regular monitoring of antiepileptic drug treatment was continued at least for one year. Associations between seizure control and potential predictors were determined by multivariate analysis.RESULTS Three hundred and ninety children were enrolled in 6 months, of whom over 60% were from low-income families, 60% had onset at under 1 year, 74% had more than one seizure per week, 69% a single-seizure type, and 38% a history of delayed onset of breathing at birth. Cognitive deficits (IQ<70; 58%) and ⁄ or motor (significant limitation of daily living activities; 47%) deficits were common. After 1 year of regular treatment, seizure control was good (seizure freedom) in 53%, and poor (at least one seizure in the last 3mo of follow-up) in 47%. The predictors of poor seizure control were an IQ<70, associated motor disability, multiple seizure types, and a history of cognitive regression (1.9 times more likely to have poor seizure control).INTERPRETATION Seizure control can be predicted using three clinical factors (motor disability, cognitive impairment, and multiple seizure types) at the first clinic visit. Such predictors assist the development of referral plans and management guidelines for childhood epilepsies in resourcepoor countries.The management of childhood epilepsy in countries with limited resources has several specific problems. These include lack of medical resources, misunderstanding of the nature of epilepsy, stigmatization, large treatment gaps (i.e. a high percentage of the target population not receiving medication but often a high level of use of traditional healers), and a lack of understanding of the priorities of the users by those seeking to provide treatment. All of these issues arise in the management of epilepsy in children in Bangladesh. In consultation with parents, we formed the view that the ability to predict seizure control with future treatment can be useful. First, it provides an audit so that if the control is widely discrepant from that predicted, a reason may be sought (e.g. seizures were not epileptic, antiepileptic drugs were not taken). Second, it gives the family and patient an expectation of what antiepileptic drugs can achieve and whether they are essential to management. Third, it allows an approximate cost-benefit analysis to be performed. These may be useful in any setting, but in a country with limited resources (e.g. Bangladesh) this may allow doctors and carers to deploy their resources more effectively. The second broad issue raised was the high rate of additional problems of development and behaviour th...

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“…For most children, epilepsy is readily controlled with current anticonvulsant treatment and they are able to lead a normal life. However, in a sizeable minority of from 20-30% of cases (Brorson & Wranne, 1987), the seizures are not controllable by current treatments, with subsequent severe disruption to their lives, interference with learning, emotional, behavioural and school problems and the risk of prolonged seizures. This group of intractable epilepsies is heterogeneous, comprising patients with complex partial seizures, Lennox-Gastaut syndrome, myoclonic epilepsies, West syndrome and other mixed and unclassifiable seizure disorders.…”

Section: Introductionmentioning

confidence: 99%