Defining early seizure outcomes in pediatric epilepsy: The good, the bad and the in-between

Anne T. Berg, Shlomo Shinnar, Susan R. Levy, Francine M. Testa, Susan Smith-Rapaport, Barbara Beckerman, Nader Ebrahimi

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

Purpose: To examine different approaches to classifying seizure outcomes. Methods: In a prospective cohort study of children (N=613) with newly diagnosed epilepsy, seizure outcomes at 2 years were classified as 'good' (≥1 year remission), 'bad' or 'intractable' (≥2 AED failures, ≥1 seizure/month over ≥18 months), and 'indeterminate' (neither 'good' nor 'bad'). Outcomes at 2 years were compared to outcomes in those followed 4 or more years. The associations of three commonly studied prognostic factors, etiology, age at onset, and syndromic grouping with the three-level outcome were assessed. Results: 595 (97.1%) children were followed ≥2 years. A 'good', indeterminate, and 'bad' outcome was present in 314 (52.8%), 235 (38.3%), and 46 (7.7%) children. Problems with treatment were recorded in 64.7% of the indeterminate group. In 390 children followed ≥4 years, early 'good' and 'bad' outcomes persisted in ∼80%. About half of those with indeterminate 2-year outcomes later achieved remission, 8% met criteria for intractability, and 37% remained indeterminate. Most of the associations with etiology, age, and syndrome were due to variation in the proportion that met criteria for intractability and not remission. Conclusions: Many children have indeterminate outcomes, often in association with treatment issues. Clearly 'good' and 'bad' early outcomes can be identified and persist ≥2 years later. In the absence of pharmaco-resistance, lack of early remission (indeterminate outcome) is usually not associated with a bad outcome, at least over the next few years.

Original languageEnglish (US)
Pages (from-to)75-84
Number of pages10
JournalEpilepsy Research
Volume43
Issue number1
DOIs
StatePublished - 2001

Fingerprint

Epilepsy
Seizures
Pediatrics
Age of Onset
Cohort Studies
Prospective Studies
Therapeutics

Keywords

  • Intractable epilepsy
  • Predittion
  • Prognosis
  • Remission
  • Seizure outcomes

ASJC Scopus subject areas

  • Clinical Neurology
  • Pediatrics, Perinatology, and Child Health
  • Neurology

Cite this

Berg, A. T., Shinnar, S., Levy, S. R., Testa, F. M., Smith-Rapaport, S., Beckerman, B., & Ebrahimi, N. (2001). Defining early seizure outcomes in pediatric epilepsy: The good, the bad and the in-between. Epilepsy Research, 43(1), 75-84. https://doi.org/10.1016/S0920-1211(00)00184-4

Defining early seizure outcomes in pediatric epilepsy : The good, the bad and the in-between. / Berg, Anne T.; Shinnar, Shlomo; Levy, Susan R.; Testa, Francine M.; Smith-Rapaport, Susan; Beckerman, Barbara; Ebrahimi, Nader.

In: Epilepsy Research, Vol. 43, No. 1, 2001, p. 75-84.

Research output: Contribution to journalArticle

Berg, AT, Shinnar, S, Levy, SR, Testa, FM, Smith-Rapaport, S, Beckerman, B & Ebrahimi, N 2001, 'Defining early seizure outcomes in pediatric epilepsy: The good, the bad and the in-between', Epilepsy Research, vol. 43, no. 1, pp. 75-84. https://doi.org/10.1016/S0920-1211(00)00184-4
Berg, Anne T. ; Shinnar, Shlomo ; Levy, Susan R. ; Testa, Francine M. ; Smith-Rapaport, Susan ; Beckerman, Barbara ; Ebrahimi, Nader. / Defining early seizure outcomes in pediatric epilepsy : The good, the bad and the in-between. In: Epilepsy Research. 2001 ; Vol. 43, No. 1. pp. 75-84.
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AU - Ebrahimi, Nader

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N2 - Purpose: To examine different approaches to classifying seizure outcomes. Methods: In a prospective cohort study of children (N=613) with newly diagnosed epilepsy, seizure outcomes at 2 years were classified as 'good' (≥1 year remission), 'bad' or 'intractable' (≥2 AED failures, ≥1 seizure/month over ≥18 months), and 'indeterminate' (neither 'good' nor 'bad'). Outcomes at 2 years were compared to outcomes in those followed 4 or more years. The associations of three commonly studied prognostic factors, etiology, age at onset, and syndromic grouping with the three-level outcome were assessed. Results: 595 (97.1%) children were followed ≥2 years. A 'good', indeterminate, and 'bad' outcome was present in 314 (52.8%), 235 (38.3%), and 46 (7.7%) children. Problems with treatment were recorded in 64.7% of the indeterminate group. In 390 children followed ≥4 years, early 'good' and 'bad' outcomes persisted in ∼80%. About half of those with indeterminate 2-year outcomes later achieved remission, 8% met criteria for intractability, and 37% remained indeterminate. Most of the associations with etiology, age, and syndrome were due to variation in the proportion that met criteria for intractability and not remission. Conclusions: Many children have indeterminate outcomes, often in association with treatment issues. Clearly 'good' and 'bad' early outcomes can be identified and persist ≥2 years later. In the absence of pharmaco-resistance, lack of early remission (indeterminate outcome) is usually not associated with a bad outcome, at least over the next few years.

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KW - Remission

KW - Seizure outcomes

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