Publication:

Childhood epilepsy: a study of etiological and prognostic factors for failure of remission at a tertiary care government hospital, a prospective COHORT study

Background This study was carried out to identify early predictive factors of medically intractable childhood epilepsy. We also aimed to explore the prognosis in terms of remission with anti-epileptic drug (AED) treatment and to identify the predictors of poor prognosis (failure of remission) in relation to the control of epilepsy.

Methods Children with epilepsy were included. Information recorded at the time of the first visit: age, gender, age at onset of epilepsy, patient history, AED treatment and Seizure control. Details of general and neurological examination were also recorded. These patients were then followed up over a one-year period to assess for remission and patient compliance with medication.

Results A total of 239 patients between the ages of 1 month and 12 years were diagnosed with epilepsy according to the International league against epilepsy (ILAE) classification. Of these 213 patients followed up. Among these, 126 (59.1%) patients attained remission while 87 (40.8%) patients failed to attain remission. Age of onset less than 1 year, microcephaly, developmental delay at diagnosis, a definite etiology, infantile spasms, structural abnormality detected on neuroimaging, abnormal electro-encephalography (EEG) and the requirement for polytherapy to achieve seizure control were found to be associated with a poor prognosis (failure of remission).

Conclusions The poor prognostic factors for childhood epilepsy at diagnosis are age of onset <1 year, microcephaly, infantile spasms, structural abnormality on neuroimaging and abnormal EEG. At follow up patients requiring an add-on AED to pre-existing treatment regimen is associated with a lesser likelihood of achieving remission.