Neuropsychiatric Outcomes in Childhood Epilepsy Predicted by Seizure Frequency
The strongest predictor for neuropsychiatric diagnosis was seizure count.
WASHINGTON, DC — Findings from a large prospective study presented at the 2017 American Epilepsy Society Annual Meeting, December 1-5, in Washington, DC, suggest that total number of seizures in children with benign childhood epilepsy with centrotemporal spikes (BECTS), not age at first seizure, is predictive of neuropsychological outcomes.
To evaluate prognostic causes of disease course and to examine whether there are clinical features or treatments associated with neuropsychiatric outcomes, the researchers included all patients with BECTS who were in the long-term Connecticut Study of Epilepsy (n=61) in the current study.
Participants were enrolled at diagnosis and were contacted every 3 months to track disease course, medication, and neuropsychiatric status into young adulthood. Average follow-up for children with BECTS was 15.86±3.38 years. Mann-Whitney and Welch's t-tests were used to do group comparisons between those who were treated and untreated, and a logistic regression model was used to evaluate the relationship between clinical variables and neuropsychological outcome.
The researchers found that average age at the first and last seizure were 7.2 (range 3.1-10.6) and 10.0 years (range 4.3-22.3). Of the 61 participants included in the study, 40 were treated with anticonvulsant medication (ACD). The participants' age at first seizure did not correlate with observed duration of disease (R2 =.00), nor with the total number of seizures (R2 =.03).
While examining untreated vs treated participants, the researchers found no difference in average age of first seizure (P =.59), median early seizure frequency (P =.91), median duration of disease (time from first to last seizure) (P =.98), or median total seizure count (P =.11). Median duration of ACD treatment was 3.0 years (range .7-10.8); this was significantly longer than observed duration of disease in treated participants (P =.02).
After 1 year without seizures, 18 of the 61 participants experienced a relapse. Of the 18 who experienced relapse, 12 were in the treated group, 6 were attributed to missed or tapered ACD doses, and 7 were unexplained. In untreated participants, 1 relapse had a clear inciting factor, and 4 were unexplained.
Of the total cohort, 18 reported at least 1 neuropsychiatric diagnosis over the follow-up period. The most common diagnosis was depression (n=12) and attention-deficit hyperactivity disorder (n=11).
The strongest predictor for neuropsychiatric diagnosis was seizure count (P =.004). Factors that did not significantly predict neuropsychiatric diagnosis included age at onset (P =.38), observed duration of disease (P =.25), and duration of ACD treatment (P =.75).
“This large prospective study demonstrates that age at first seizure is not an accurate prognostic marker, predicting neither number of seizures nor observed duration of disease,” the researchers concluded. “Nearly one-third of this cohort was diagnosed with a neuropsychiatric complication, with the major predicting factor of these diagnoses being total number of seizures.”
Ross EE, Song DY, Ostrowki LM, Berg AT, Chu CJ. Seizure count, not age nor treatment, correlates with neuropsychological outcome in BECTS. Presented at: American Epilepsy Society Annual Meeting. December 1-5, 2017; Washington, DC. Abstract 2.206.