9 research outputs found
Idiopathic first seizure in adult life
This thesis is based on a prospective investigation of 226 patients aged 15
years and older, who were referred to one of the participating hospitals
due to a possible idiopathic first seizure. Only those patients were admitted
to the study in whom an obvious cause on clinical grounds for the occurrence
of the seizure was lacking. A standard EEG, an EEG after partial sleep
deprivation and a computerised tomography scan (CT scan) were obtained
in all patients. None of the patients were treated with antiepileptic drugs,
unless a second seizure occurred. Follow-up in all patients was 1 - 2 years
Parent-completed scales for measuring seizure severity and severity of side-effects of antiepileptic drugs in childhood epilepsy: development and psychometric analysis.
We have developed two outcome measures for childhood epilepsy: a seizure severity (SS) scale and a side-effects (SE) scale. Both scales have been designed for completion by parents. The scales were tested in two pilot phases and the results of this stepwise analysis are described here. The final scales' psychometric properties were assessed in a group of 80 children with active epilepsy, representative of the population at whom the scales were aimed: children with chronic epilepsy, aged 4-16 years, including all seizure types and epilepsies, as well as children with neurological comorbidity. The SS scale and SE scale showed good internal consistency and test-retest stability. Although there was a significant positive correlation between the SS scale and the SE scale, this was low, indicating that the scales measure a different clinical trait. The SE scale consisted of two subscales: a Toxic subscale, measuring the severity of dose-related side-effects, and a Chronic subscale, measuring the severity of long-term behavioural and cognitive side-effects. These subscales for side-effects showed a high correlation and can be used as a joint scale. These scales have the potential to improve outcome assessment in childhood epilepsy and they can be used to assess important aspects of quality of life in this population
Epilepsy in childhood: an audit of clinical practice.
It is not known how many children with epilepsy may not need treatment with antiepileptic drugs (AEDs), how many respond unsatisfactorily to subsequent treatment regimens, and how many achieve "acceptable control" despite lack of remission. METHODS: In a prospective multicenter hospital-based study, 494 children with a broad range of seizure types and types of epilepsy were followed up for at least 2 years. There was no standard treatment protocol. We describe the treatment strategies applied to these children by the neurologists in charge and outcome with respect to remission from seizures. RESULTS: Treatment was initially withheld in 29% of the children, and after 2 years 17% still had not received any AEDs. There were no serious complications caused by withholding treatment. Of the children treated with AEDs, 60% were still using the first AED after 2 years; 80% received monotherapy and 20%, polytherapy. Children with severe symptomatic epilepsies, such as the West or Lennox-Gastaut syndrome, received polytherapy early on in the course of treatment. When 3 regimens had failed, the chance of achieving a remission of more than 1 year with subsequent regimens was 10%. Nevertheless, 15 of 50 children receiving AEDs in whom the "longest remission ever" was less than 6 months did achieve acceptable seizure control according to the neurologist in charge of treatment. Hence, of 494 children, only 35 (7%) developed an intractable form of epilepsy, defined as failure to bring seizures under acceptable control. CONCLUSIONS: A substantial percentage of children with new-onset epilepsy did not need treatment with AEDs. Chances of achieving a good outcome declined with subsequent treatment regimens. Not all children with recurrent seizures were suffering from intractable epilepsy; some had achieved acceptable control of seizures
Course and prognosis of childhood epilepsy: 5-year follow-up of the Dutch study of epilepsy in childhood.
Knowing the prognosis of epilepsy will undoubtedly influence the treatment
strategy. This study aimed to define the prospects of newly diagnosed
childhood epilepsy, assess the dynamics of its course, identify relevant
variables and develop models to assess the individual prognosis. Four
hundred and fifty-three children with newly diagnosed epilepsy were
followed for 5 years. Terminal remission at 5 years (TR5) was compared
with terminal remission at 2 years (TR2) and with the longest remission
during follow-up. Variables defined at intake and at 6 months of follow-up
were analysed for their prognostic relevance. In multivariate analyses,
combinations of variables were tested to develop reliable models for the
calculation of the individual prognosis. Data on treatment, course during
follow-up and epilepsy syndromes were also studied. Three hundred and
forty-five children (76%) had a TR5 >1 year, 290 (64%) >2 years and 65
(14%) had not had any seizure during the entire follow-up. Out of 108
children (24%) with TR5 <1 year, 27 were actually intractable at 5 years.
Medication was started in 388 children (86%). In 227 of these (59%),
anti-epileptic drugs (AEDs) could be withdrawn. A TR5 >1 year was attained
by 46% on one AED, on the second AED by 19%, and by 9% on all additional
AED regimes. Almost 60% of the children treated with a second or
additional AED regime had a TR5 >1 year. Variables predicting the outcome
at intake were aetiology, history of febrile seizures and age. For intake
and 6-month variables combined, sex, aetiology, postictal signs, history
of febrile seizures and TR at 6 months were significant. The model derived
from intake variables only predicted TR5 <1 year correctly in 36% and TR5
>1 year in 85% (sensitivity 0.65, specificity 0.64). The corresponding
values for the model derived from intake and 6-month variables were 43 and
88% (sensitivity 0.69, specificity 0.71). The course of the epilepsy was
constantly favourable in 51%, steadily poor in 17%, improving in 25% and
deteriorating in 6%. Intractability was in part only a temporary
phenomenon. The outcome at 5 years in this cohort of children with newly
diagnosed epilepsy was favourable in 76%; 64% were off medication at that
time. Almost a third of the children had a fluctuating course; improvement
was clearly more common than deterioration. After failure of the first
AED, treatment can still be successful. Models predicting the outcome have
fewer misclassifications when predicting a long terminal remission than
when predicting continuing seizures
Auditory perceptual styles of process and reactive schizophrenics as measured by The Sound Test
There is no abstract available for this research paper.Thesis (M.A.