Predicting Intractable Epilepsy in Children
A study, published in the June issue of Neurology, the journal of the American Academy of Neurology, may help neurologists to predict which children with epilepsy will not respond well to the most common medications. The medical, social and economic consequences of poorly controlled seizures can be enormous. Identifying these children might allow caregivers to determine earlier which children would be most appropriate candidates for treatment with more aggressive therapies (surgery, vagus nerve stimulation, the ketogenic diet, new drugs, drugs with higher potential risks of side effects).
The study followed 613 children with newly diagnosed epilepsy in Connecticut for an average of nearly 5 years. Of those children, 10% met the criteria for intractable epilepsy [difficult to treat, defined as the failure of 2 or more first-line antiseizure medications to control seizures in children who experienced 1 or more seizures per month for 18 months].
Researchers identified children with cryptogenic generalized epilepsy as having the greatest risk of developing intractable epilepsy. Children who were previously neurologically normal are usually young — often younger 1 year of age — when they have their first seizure. More often it occurs in children who were known to have neurological abnormalities. 35% percent of the children in the study with this type of seizure disorder met the criteria for intractable epilepsy, compared with 8% of those with other forms of epilepsy.
Also at high risk are those whose seizures occurred frequently when they first developed. Only 1% of children with <1 seizure per month met the criteria for intractability. The percentage increased with increasing seizure frequency and reached a maximum of nearly 27% in those with 200 or more seizures per month.
Children with slower electroencephalogram (EEG) activity were also more likely to have intractable epilepsy than children with normal EEGs or with other EEG abnormalities common in epilepsy.
Initial seizure frequency and EEG activity were shown to be important in children with non-idiopathic partial epilepsy (representing almost 50% of the study group). Partial epilepsies are most responsive to surgery if medications fail.
Researchers state that large studies are needed to compare and evaluate several new medications and dietary and surgical techniques for treating epilepsy.
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