Course and Long-Term Outcome of Childhood-Onset Epilepsy: Dutch study of epilepsy in childhood

In a hospital-based study, 494 children with epilepsy were prospectively followed up from the time of diagnosis. The main objective of this study was to investigate the course of childhood-onset epilepsy during a period of 15 years. Generally, medication is withdrawn after a 2-year remission. Here, subjects with a fast response to medication were randomized for 6- or 12 month treatment. Four years later, we found no difference in recurrence rate, terminal remission, or adverse events between both groups. Unnecessary treatment was prevented for >1 year, but after recurrences renewed medication sometimes failed. We cannot recommend early withdrawal in all fast responders. At last contact, a 5-year terminal remission was reached by 71% of the cohort and 9% was intractable. Course during follow-up was favorable in 50%, improving in 29%, and poor or deteriorating in 16%. Duration of seizure activity was 12 years in another 25%. Antiepileptic drugs were used by 86%. Mortality was significantly higher only in the remote symptomatic group. The idiopathic and cryptogenic etiology groups resembled their Dutch age-peers in having a partner/ offspring and in employment status, but the educational and occupational achievements of the idiopathic group were lower than expected. This might be due to their epilepsy, or to an assumed common cause for the epilepsy and other brain dysfunctions. Time of onset, course, and duration of intractability can differ between subjects with epilepsy and are hardly predictable, even though intractability itself can be predicted to a certain extent. The natural course of epilepsy probably best explains the variability of intractability and the effect of medication seems to be minor

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.