Risk Factors Predicting Refractoriness in Epileptic Children with Partial Seizures

Abstract

The aim of this retrospective study was to determine the risk factors associated with intractability to therapy in childhood epilepsy. Fifty children with intractable epilepsy as evidenced by at least 1 epileptic fit per month were included in the study group, whereas the control group consisted of children who did not experience any recurrent seizure for at least 1 year at the time of the study. A chi( 2) test was used to evaluate the relationship between the test variables for the 2 groups, and the estimated relative risk (odds ratio) for each variable was calculated. The risk factors were subsequently determined by logistic multiple regression analysis. Univariate analysis showed that mental retardation, neurological abnormality, neuroradiological abnormality, perinatal anoxia, neonatal convulsion, presence of status epilepticus, and symptomatic etiology were significant risk factors for the development of refractory epilepsy (P < .05). For multivariate logistic regression analysis, age at seizure onset, status epilepticus, mixed type of seizures, and history of frequent seizures (more than once a month) were all found to be significant and independent risk factors for refractory epilepsy, and the number of drugs used in the study group was significantly higher than that in the control group (P < .05). In line with these findings, it was concluded that children who present with epilepsy and have these risk factors should be referred to a center where epileptic surgery is carried out without delay.

Predictors and Typical Clinical Findings of Refractory Epilepsy

“…Our results support the conclusion of many scientists about the significant association of the childhood onset of epilepsy with its treatment resistance [2,3,4,[6][7][8][9][10][11][12]19,21,22,23,27,28,29]. This variable has been accepted as one of the most significant predictors of intractability as well.…”

“…Epileptic status (especially the neonatal and the acute symptomatic status) and more rarely the seizure clusters have been determined as significant predictors of RE in scientific literature [3,4,9,16,17,22,31,33]. According to our results, these clinical findings are typical of RE and intractability predictors.…”

“…Complex febrile seizures and a febrile epileptic status [1,3,4,5,6]; 4. An early onset of epileptic seizures (especially before 1 year of age), a high initial seizure frequency and duration, clusters of seizures and an epileptic status, a long period between the first seizure and the beginning of treatment with antiepileptic drugs (AED) [2,3,4,[7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]; 5. Infantile spasms, atonic seizures in the disease course and according to some investigators-generalized tonic and simple partial seizures [16,19,22]; 6.…”

“…Infantile spasms, atonic seizures in the disease course and according to some investigators-generalized tonic and simple partial seizures [16,19,22]; 6. Focal neurological signs which are usually associated with a brain lesion [9,22]; 7. A poor answer to the first AED [2,10,13,15,19,23,24,25].…”

Early clinical predictors of intractable epilepsy in childhood

“…The identification of risk factors for intractability in childhood epilepsy has become a major research focus, but very few data exist for the Turkish population (3,4).…”