Long-term use of oxcarbazepine oral suspension in childhood epilepsy: open-label study

Studies designed specifically for the pediatric population are needed to assess the tolerability and safety of the new antiepileptic drugs. The purpose of this study was to document the safety, ease of dosing, and acceptance of oxcarbazepine oral suspension in pediatric patients in monotherapy and polytherapy. A prospective, multicenter, open-label study was conducted at the neurology services of three pediatric university hospitals over 12 months. After obtaining signed informed consent, we enrolled a series of 62 patients with epilepsy aged between 2 months and 14 years who began oxcarbazepine treatment in monotherapy or in combination with other antiepileptic drugs to assess the seizure frequency, safety (adverse events), and acceptance of the pharmaceutical form by the patient's family. Fifty patients (80.6%) reduced seizures by at least 50%, 44 (71%) saw a reduction in seizure frequency of over 75%, and 29 (46.8%) were seizure free at the end of the study. The difference in the number of seizures before and after the study was statistically significant, both overall and by type of pathology. Adverse events occurred in four patients (6.4%) and required withdrawal of the drug in two cases (skin rash); three patients (4.8%) withdrew for inefficacy. Five patients (8.1%) withdrew from the treatment. We concluded that, in this series of patients, oxcarbazepine in oral suspension form was seen to help reduce seizure frequency, to have few side effects, and to be accepted by parents and patients.     

A study of the incidence of epilepsy following ECT

In a group of 166 patients who had received electroconvulsive therapy more than one year previously the prevalence of epilepsy did not differ significantly from that found in the community as a whole. The findings suggest that a kindling process is not a clinical hazard following repeated electrically induced seizures.     

A study of idiopathic generalised epilepsy in an Irish population.

Idiopathic generalised epilepsy (IGE) is subdivided into syndromes based on clinical and EEG features. PURPOSE: The aim of this study was to characterise all cases of IGE with supportive EEG abnormalities in terms of gender differences, seizure types reported, IGE syndromes, family history of epilepsy and EEG findings. We also calculated the limited duration prevalence of IGE in our cohort. METHODS: Data on abnormal EEGs were collected retrospectively from two EEG databases at two tertiary referral centres for neurology. Clinical information was obtained from EEG request forms, standardised EEG questionnaires and medical notes of patients. RESULTS: two hundred twenty-three patients met our inclusion criteria, 89 (39.9%) male and 134 (60.1%) females. Tonic clonic seizures were the most common seizure type reported, 162 (72.65%) having a generalised tonic clonic seizure (GTCS) at some time. IGE with GTCS only (EGTCSA) was the most common syndrome in our cohort being present in 94 patients (34 male, 60 female), with 42 (15 male, 27 female) patients diagnosed with Juvenile myoclonic epilepsy (JME), 23 (9 male, 14 female) with Juvenile absence epilepsy (JAE) and 20 (9 male, 11 female) with childhood absence epilepsy (CAE). EEG studies in all patients showed generalised epileptiform activity. CONCLUSIONS: More women than men were diagnosed with generalised epilepsy. Tonic clonic seizures were the most common seizure type reported. EGTCSA was the most frequent syndrome seen. Gender differences were evident for JAE and JME as previously reported and for EGTCSA, which was not reported to date, and reached statistical significance for EGTCA and JME.     

A pilot study of topiramate in childhood absence epilepsy

Piña‐Garza JE, Schwarzman L, Wiegand F, Hulihan J. A pilot study of topiramate in childhood absence epilepsy.
Acta Neurol Scand: 2011: 123: 54–59.
© 2010 The Authors Journal compilation © 2010 Blackwell Munksgaard. Objective – Evaluate the antiepileptic effect of topiramate monotherapy in childhood absence epilepsy (CAE). Materials and Methods – Childhood absence epilepsy patients aged 4–9 years were initiated with topiramate 15 or 25 mg/day, which was titrated upwards until patients were free of absence seizures. The primary efficacy outcome was seizure‐free rates after a 12‐week maintenance period. Results – The study was terminated early due to lack of efficacy after enrollment of 12 patients. Four patients completed the study; two became clinically seizure‐free, but without a significant reduction in the number of electrographic seizures. Six patients discontinued for lack of efficacy, none due to adverse events (AEs). Mean reduction in seizure count was seen on Days 22 (P = 0.0391) and 36 (P = 0.0156) and percentage of days with seizures decreased from baseline. Most AEs were mild. Conclusions – Although well‐tolerated, this pilot study did not demonstrate an antiepileptic effect of topiramate monotherapy for treatment of CAE.     

Regional differences and secular trends in the incidence of epilepsy in Finland: a nationwide 23-year registry study

Purpose: Regional variations and temporal trends in the incidence of new‐onset epilepsy are clinically important and may offer clues on how to prevent epilepsy. Methods: We examined regional differences and secular trends in the incidence of new‐onset epilepsy in the Finnish population based on the nationwide full‐refundable antiepileptic drug registry and the population registry in the years 1986–2008. Key Findings: The overall incidence of epilepsy was significantly higher in eastern Finland than in middle [risk ratio (RR) 1.08 (95% confidence interval, CI 1.05–1.12)), p < 0.0001] and western Finland [RR 1.32 (1.30–1.35), p < 0.0001] but it was declining from 1986 to 2008 in all regions [RR 0.83 (0.81–0.84), p < 0.0001]. The mean annual decline was 0.6%. Although the incidence of epilepsy was falling from 1986 to 2008 in childhood [annual decline 1.9%, RR 0.80 (0.75–0.86), p < 0.0001] and in middle age [annual decline 0.8%, RR 0.88 (0.84–0.93), p < 0.0001], it increased significantly in the elderly (age 65 years or older) in all of Finland [annual increase 3.5%, RR 1.25 (1.18–1.33), p < 0.0001], and particularly in east versus west Finland [RR 1.48 (1.42–1.55), p < 0.0001]. As a result, starting with the year 2000, the incidence rate of epilepsy was higher in the elderly than in children for all of Finland. Significance: In view of the falling incidence of epilepsy in childhood and middle‐age in all of Finland from 1986 to 2008, the significant increase in the incidence of epilepsy in the elderly is of concern. The regional increase of epilepsy may offer clues for allocating resources and, possibly, population epileptogenesis between west and east Finland and for strategies to prevent epilepsy in the elderly.     

The early prognosis of epilepsy in childhood: the prediction of a poor outcome. The Dutch study of epilepsy in childhood.

PURPOSE: To examine which variables available early in the course of childhood epilepsy are associated with a poor short-term outcome and to develop models to predict such an outcome. METHODS: We prospectively followed up 466 children with newly diagnosed epilepsy for 2 years. Variables were collected at intake and after 6 months. Outcome was defined as the duration of the terminal remission (TR): poor (<6 months) and not poor (> or =6 months). RESULTS: Of the subjects, 31% had a poor outcome. Multivariate analysis based on the intake variables identified number of seizures, seizure type, and etiology as risk factors for a poor outcome. With the intake and 6-month variables combined, seizure type, etiology, the number of seizures, and not attaining a 3-month remission during these 6 months, and the EEG at 6 months were predictive variables. A predictive model based on the multivariate logistic-regression analysis with the intake variables was correct in 56% of the children in whom it predicted a poor outcome and in 73% of the children in whom it predicted a not-poor outcome. With the intake and 6-month variables together, these percentages were 66 and 79%, respectively. The sensitivity of these models was low (29 and 47%, respectively); the specificity was good (90 and 89%). CONCLUSIONS: The 2-year outcome of childhood epilepsy is closely related to its early course. The prognosis is poor in approximately 30% of patients. By using our data, the prediction of a poor outcome is correct in almost two thirds of the patients; however, the models produce many false-negative predictions.     

A study on visual evoked responses in childhood epilepsy with occipital paroxysms.

As some apparently idiopatic epilepsies may occasionally pose diagnostic difficulties in regard to their precise status of etiology, evoked potentials, particularly visual evoked potential (VEP), may contribute to the diagnosis of childhood epilepsy with occipital paroxysms (CEOP) as a subsidiary method of evaluation. This study includes 19 children (10 boys 52.6%; 9 girls 47.4%) ranging in age from 5 to 17 years (mean SD = 9.68 3.28) suffering from CEOP and a control group of 30 normal children, matched for chronological age and sex. Peak amplitudes and latencies of the P100 component for pattern-shift VEP (PVEP) and of major positivity for flash VEP (FVEP) are measured, respectively. The results from this study demonstrate that amplitude and latency values in patients with CEOP differs insignificantly when compared with controls. Although, non-significantly, mean values of amplitudes for both PVEP and FVEP were higher in the patients than in the normal children, whereas latencies in FVEP were somewhat longer. There may be some tendency for the amplitudes to increase and the latencies to be delayed in VEPs in patients with CEOP, when an overall interpretation of our and similar studies are considered. In certain cases of diagnostic difficulty, VEP values may provide further information for the clinician, regarding either a symptomatic or an idiopathic nature of the underlying disorder.     

Vigabatrin in intractable childhood epilepsy: a retrospective study.

The effects of vigabatrin were studied over a 6-month period in 43 patients with intractable epilepsy. Children with complex partial seizures, with or without secondary generalization, responded best with more than one-half achieving a greater than 50% reduction; generalized tonic-clonic seizures also improved but there was no significant change in absence or myoclonic seizures. Four patients are seizure-free on monotherapy with vigabatrin. The drug was well tolerated with few side effects.     

A study of drug-resistant childhood epilepsy testing the new ILAE criteria

PurposeTo test the new ILAE definition of drug-resistant epilepsy in a cohort study.MethodsAll children younger than 14 with two or more unprovoked seizures observed at our hospital between 1994 and 2008 were included.ResultsFive hundred and eight patients were followed for an average of 90 months (range 24–168). The probabilities of achieving seizure freedom, according to the ILAE criteria, with the first, second, third and fourth and subsequent therapeutic regimens were 65%, 29%, 27% and 21%, respectively. In the cohort, 87 patients met the criteria for drug-resistant epilepsy, which represents 19% of the treated patients (n = 459) and 17% of the overall sample. The probability of meeting the criteria for drug-resistant epilepsy was 11%, 11% and 13% at 2, 6 and 10 years respectively. Sixty two percent of drug resistant cases were younger than 4 years old, 73% had an associated developmental delay and/or motor deficit, 42% had an identifiable structural cause of epilepsy and 32% had a specific epileptic syndrome. For drug-resistant patients who tried additional therapeutic regimens, the probability of achieving a seizure-free state without further recurrences was 23% and 27% at three and five years, respectively.ConclusionsCompared with more stringent criteria, the new ILAE criteria classify a greater number of patients with drug-resistant epilepsy. A significantly higher proportion of cases meeting this definition subsequently enter remission. A definition of drug-resistance that includes the additional criteria of failure of a third antiepileptic drug or high seizure frequency may better identify patients with truly drug-resistant epilepsy.     

Incidence of childhood epilepsy: A population-based study in rural Japan

Introduction

Epilepsy is a common childhood neurological condition and a major public health concern worldwide. A higher incidence of epilepsy is reported in low- and middle-income countries, particularly in rural areas. However, no Japanese reports on the incidence of childhood epilepsy have been published in the past 25 years. We estimated the annual incidence of epilepsy in children aged 1–14 years in Uwajima, a city in a rural, relatively isolated area of Japan.

Long-term survival after epilepsy surgery compared with matched epilepsy controls and the general population

This study evaluates if there was a difference in long-term survival between epilepsy surgery patients, individually matched controls with intractable epilepsy, and controls from the general population. In a cohort study, we compared the survival of patients operated with epilepsy surgery in Norway 1948-1988 with: (1) a control group with prolonged medical treatment for intractable epilepsy individually matched for age, gender, and seizure type (n = 139), and (2) expected mortality for matched individuals in historical cohorts of the general population (n = 196). Survival was compared using Kaplan-Meier curves and stratified proportional hazards analysis. After on average 25 years of observation after surgery, there was no difference in survival between the epilepsy surgery group and the controls with intractable epilepsy (p = 0.18). The risk ratio for death after epilepsy surgery was 0.6 (95% CI 0.4-1.1; p = 0.08) compared with the control group. However, survival of epilepsy surgery patients was lower than that of a matching general population (p < 0.001), with a risk ratio for death of 6.2 (95% CI 3.1-12.6; p < 0.001). In this long-term study of a national cohort of epilepsy surgery patients, we found no beneficial effect of epilepsy surgery on survival compared with a control group of medically treated patients with intractable epilepsy. The mortality after epilepsy surgery was higher than expected in the general population.     

儿童枕叶癫痫68例随访研究

目的 探讨儿童枕叶癫痫的预后,方法 对１９８４年８月至１９９６年６月我院收治物６８例儿童枕叶癫痫患者进行了２－１２随访观察。结果 停止发作６５例（９６％）;停药后复发５例（８％）;脑电图异常随临床症状缓解而消失;病因明确者治疗较为困难。结论;枕叶癫痫患儿在药物控制发作１－２年后,脑电力产恢复正常者可以停药。