DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20213311

Children with idiopathic generalized epilepsy those underwent at least two years seizure remission: a retrospective analysis

Chandan Raybarman

Abstract


Background: The aim of the retrospective study was to evaluate the effectiveness of the index antiepileptic drugs in children with idiopathic generalized epilepsy who underwent at least 2 years remission.

Methods: A total of 52 children with idiopathic generalized epilepsy who underwent at least 2 years remission were identified retrospectively from the records of the paediatric and neurology care clinic from April 2017 to December 2020.

Results: The seizure patterns of 52 cases were tonic-clonic seizures alone (73%), a combination of tonic-clonic seizures and absences (13.5%), and combined tonic-clonic seizures and myoclonus (13.5%).  The total number of seizures at enrolment in all (age at seizure onset 7.44±5.12 years, male-female ratio (31:21) was 651 (mean 12.52±26.60). The total number of follow-up visits in all was 6.62±14.44 consisting of 1177.5±772.86 days of follow-up periods. All patients continued index antiepileptic drugs with initial target doses varies from low to moderate ranges. Add-on therapy was initiated in 43% of cases around the titration phase of index antiepileptic drugs (i.e. very early add-on). Treatment trends reveal increased use of 1st generation antiepileptic drugs than 2nd and 3rd generation. 2 years seizure remission rates were 55.77% by index antiepileptic drugs only therapy and 44.23% by very early add-on therapy.  The seizure remission period was mean±SD 858.71±209.08 days.

Conclusions: Index antiepileptic drugs with low to moderate initial target doses lead to achieving 2 years or more seizure remission. Very early add-on therapy is the novelty and leads to achieving the goal.


Keywords


Idiopathic generalized epilepsy, Index antiepileptic drugs, Very early add on, 2 years seizure remission, Initial target doses

Full Text:

PDF

References


Camfield P, Camfield C. Incidence, prevalence and aetiology of seizures and epilepsy in children. Epileptic Disord. 2015;17(2):117-23.

Berg AT, Levy SR, Testa FM, Shinnar S. Classification of childhood epilepsy syndromes in newly diagnosed epilepsy: interrater agreement and reasons for disagreement. Epilepsia. 1999;40(4):439-44.

Wirrell EC, Grossardt BR, Kisiel LC, Nickels KC. Incidence and classification of new-onset epilepsy and epilepsy syndromes in children in Olmsted County, Minnesota from 1980 to 2004: a population-based study. Epilepsy Res. 2011;95(1):110-8.

Scheffer IE, Berkovic S, Capovilla G, Connolly MB, French J, Guilhoto L, et al. ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017;58(4):512-21.

Cavanna AE. Behavioural neurology of antiepileptic drugs: a practical guide. 1st ed. Oxford University Press; 2018.

Yılmaz U, Yılmaz TS, Dizdarer G, Akıncı G, Guzel O, Tekgul H. Efficacy and tolerability of the first antiepileptic drug in children with newly diagnosed idiopathic epilepsy. Seizure. 2014;23(4):252-9.

Meyer AC, Dua T, Ma J, Saxena S, Birbeck G. Global disparities in the epilepsy treatment gap: a systematic review. Bull World Health Organ. 2010;88(4):260-6.

Sillanpaa M, Schmidt D, Saarinen MM, Shinnar S. Remission in epilepsy: How long is enough? Epilepsia. 2017;58(5):901-6.

Fisher RS, Acevedo C, Arzimanoglou A, Bogacz A, Cross JH, Elger CE, et al. ILAE official report: a practical clinical definition of epilepsy. Epilepsia. 2014;55(4):475-82.

Berg AT, Shinnar S, Levy SR, Testa FM, Rapaport S, Beckerman B, et al. Two-year remission and subsequent relapse in children with newly diagnosed epilepsy. Epilepsia. 2001;42(12):1553-62.

Poolos NP, Castagna CE, Williams S, Miller AB, Story TJ. Association between antiepileptic drug dose and long-term response in patients with refractory epilepsy. Epilepsy Behav. 2017;69:59-68.

Chen Z, Brodie MJ, Liew D, Kwan P. Treatment Outcomes in Patients With Newly Diagnosed Epilepsy Treated With Established and New Antiepileptic Drugs: A 30-Year Longitudinal Cohort Study. JAMA Neurol. 2018;75(3):279-86.

Kwan P, Brodie MJ. Effectiveness of first antiepileptic drug. Epilepsia. 2001;42(10):1255-60.

Fishman J, Kalilani L, Song Y, Swallow E, Wild I. Antiepileptic Drug Titration and Related Health Care Resource Use and Costs. J Manag Care Spec Pharm. 2018;24(9):929-38.

Powell G, Logan J, Kiri V, Borghs S. Trends in antiepileptic drug treatment and effectiveness in clinical practice in England from 2003 to 2016: a retrospective cohort study using electronic medical records. BMJ Open. 2019;9(12):32551.

Radhakrishnan A. Bridging the treatment gap in epilepsy-is there an emerging trend in the use of newer antiepileptic drugs? Neurol India. 2016;64(6):1140-2.

Hempelmann A, Taylor KP, Heils A, Lorenz S, Prud'homme JF, Nabbout R, et al. Exploration of the genetic architecture of idiopathic generalized epilepsies. Epilepsia. 2006;47(10):1682-90.

Marini C, Scheffer IE, Crossland KM, Grinton BE, Phillips FL, Mahon JM, et al. Genetic architecture of idiopathic generalized epilepsy: clinical genetic analysis of 55 multiplex families. Epilepsia. 2004;45(5):467-78.

Callenbach PM, Geerts AT, Arts WF, Donselaar CA, Peters AC, Stroink H, Brouwer OF. Familial occurrence of epilepsy in children with newly diagnosed multiple seizures: Dutch Study of Epilepsy in Childhood. Epilepsia. 1998;39(3):331-6.

Vorderwülbecke BJ, Kowski AB, Kirschbaum A, Merkle H, Senf P, Janz D, et al. Long-term outcome in adolescent-onset generalized genetic epilepsies. Epilepsia. 2017;58(7):1244-50.

Sinha S, Pramod MN, Dilipkumar S, Satishchandra P. Idiopathic generalized epilepsy: Phenotypic and electroencephalographic observations in a large cohort from South India. Ann Indian Acad Neurol. 2013;16(2):163-8.

Leung AK, Hon KL, Leung TN. Febrile seizures: an overview. Drugs Context. 2018;7:212536.

Myers KA, Scheffer IE, Berkovic SF, ILAE Genetics Commission. Genetic literacy series: genetic epilepsy with febrile seizures plus. Epileptic Disord. 2018;20(4):232-8.

Elmali AD, Auvin S, Bast T, Rubboli G, Koutroumanidis M. How to diagnose and classify idiopathic (genetic) generalized epilepsies. Epileptic Disord. 2020;22(4):399-420.

Bernasconi A, Cendes F, Theodore WH, Gill RS, Koepp MJ, Hogan RE, et al. Recommendations for the use of structural magnetic resonance imaging in the care of patients with epilepsy: A consensus report from the International League Against Epilepsy Neuroimaging Task Force. Epilepsia. 2019;60(6):1054-68.

Benbadis SR, Beniczky S, Bertram E, Maciver S, Moshé SL. The role of EEG in patients with suspected epilepsy. Epileptic Disord. 2020;22(2):143-55.