Long-term medical, educational, and social prognoses of childhood-onset epilepsy: a population-based study in a rural district of Japan

Effects of early seizures on later behavior and epileptogenicity

Both clinical and laboratory studies demonstrate that seizures early in life can result in permanent behavioral abnormalities and enhance epileptogenicity. Understanding the critical periods of vulnerability of the developing nervous system to seizure-induced changes may provide insights into parallel or divergent processes in the development of autism. In experimental rodent models, the consequences of seizures are dependent on age, etiology, seizure duration, and frequency. Recurring seizures in immature rats result in long-term adverse effects on learning and memory. These behavioral changes are paralleled by changes in brain connectivity, changes in excitatory neurotransmitter receptor distribution, and decreased neurogenesis. These changes occur in the absence of cell loss. Although impaired cognitive function and brain changes have been well-documented following early-onset seizures, the mechanisms of seizure-induced dysfunction remain unclear.

Health-related quality of life in childhood epilepsy: moving beyond 'seizure control with minimal adverse effects'

Childhood epilepsy is one of the most important and prevalent neurological conditions in the developing years. Persons with childhood onset epilepsy are at a high risk for poor psychosocial outcomes, even without experiencing co-morbidities. The goal of management of children with epilepsy should be to enable the child and the family to lead a life as free as possible from the medical and psychosocial complications of epilepsy. This comprehensive care needs to go beyond simply trying to control seizures with minimal adverse drug reactions. Seizure frequency and severity is only one important outcome variable. Other factors such as social, psychological, behavioural, educational, and cultural dimensions of their lives affect children with epilepsy, their families and their close social networks.

A number of epilepsy-specific health-related quality of life (HRQL) scales for children have been developed with the aim to include and measure accurately the impact and burden of epilepsy. Their target populations, details of the origin of the items, and psychometric properties vary significantly. Their strengths and weaknesses will be identified more clearly through their continued use in the clinical setting and in research studies. Only a few studies to date have utilized these or generic HRQL measures to assess the HRQL of specific populations with epilepsy.

Future research needs to develop theory driven models of HRQL and identify measurable factors that have important correlations with outcomes. Since biomedical variables like seizure frequency and severity have only moderate correlations with HRQL, other independent factors including the child's resilience, co-morbid conditions, parental well-being, family factors and societal/cultural variables may play a major role. We also need to learn what encompasses comprehensive patient care, define the goals of management and evaluate the impact of different interventions. Future studies need to include the children's own perspectives of their HRQL in addition to parental reports.

Finally, clinicians need to familiarize themselves with outcome measures, be able to evaluate them, and use them routinely in their day-to-day practice.

Demographic impact of epilepsy in Africa: results of a 10-year cohort study in a rural area of Cameroon

PURPOSE

To evaluate the demographic impact of epilepsy a rural area of Africa.

METHODS

A cohort study was conducted between 1991 and 2001 in the Mbam Valley (Cameroon) on two groups of subjects (one of persons with epilepsy, and the other of control individuals matched for sex, age, and village of residence). At the end of the follow-up, information on mortality, marital status, and numbers of offspring was obtained from 128 pairs of subjects.

RESULTS

Thirty-seven (28.9%) persons with epilepsy and six (4.7%) controls died between 1991 and 2001. The relative risk of dying during the follow-up among the group of people with epilepsy, compared with the controls, was 6.2 (95% CI, 2.7-14.1). The most frequent causes of death in the persons with epilepsy were status epilepticus, sudden unexpected death in epilepsy (SUDEP), and drowning. Of the 90 pairs, of which both members were still alive in 2001, 15 (16.7%) persons with epilepsy were married as compared with 53 (58.9%) controls. The mean number of children was 0.9 in the subjects with epilepsy, and 1.7 in the controls (p < 0.0001).

CONCLUSIONS

Health personnel should be trained and sensitized about the devastating effect of this neglected disease in developing countries. In those areas where onchocerciasis control programs are organized by using the community-directed-treatment approach, the possibility that the ivermectin distributors could also be responsible for distributing antiepileptic drugs should be considered.

Childhood epilepsy: what is the evidence for what we think and what we do?

This article reviews the strength of the evidence that underlies the current approach to the management of childhood epilepsy. The authors reviewed published, peer-reviewed English literature accessed through PubMed and Cochrane reviews with evidence rated as Class 1 (strongest) to Class 4 (weakest). There is considerable inaccuracy in the diagnosis of seizures and epilepsy syndromes. Sound information supports the consensus that the diagnosis of epilepsy should await two unprovoked seizures. Population-based studies indicate that remission from childhood onset epilepsy occurs in at least 50% of children. It is easier to predict a good seizure outcome than a poor one. Absence of concomitant neurologic handicap and onset before about 12 years of age are the most consistent predictors of remission. Intractability is poorly defined and difficult to predict until several antiepilepsy drugs have been used and failed to control the seizures. Most epilepsy syndrome diagnoses do not yield an accurate prognosis. Social outcome appears unsatisfactory in about 50% of cases without intellectual handicap. Death is rare in childhood epilepsy. Those without severe neurologic handicaps have the same mortality as the general population. We identified only 27 published randomized trials of antiepilepsy drugs in children that compare the efficacy of antiepilepsy drugs, offer treatment of syndromes currently without successful treatment, or have negative effects. There is a pressing need for better definitions of seizures and epilepsy syndromes. The causes of poor social outcome are unclear. Intractability needs a clear definition and randomized trials comparing treatment regimes are sadly lacking.

Leisure time and social activity after a newly diagnosed unprovoked epileptic seizure in adult age. A population-based case-referent study

PURPOSE

To investigate leisure time activity and factors that influence it in an adult cohort having newly diagnosed unprovoked epileptic seizures.

PATIENTS AND METHODS

A cohort of 62 patients > or =17 years with a newly diagnosed unprovoked epileptic seizure during 1985-87 and 93 sex- and age-matched referents were followed up regarding leisure time activity, marital status and driver's license for 10 years till 1996. Data were questionnaire derived.

RESULTS

Patients became significantly less physically active, traveled abroad less often and were generally less active during their leisure time than referents. No other significant differences were observed.

CONCLUSION

After a newly diagnosed unprovoked epileptic seizure in adult age, most leisure time activities, marital status and holding of driver's license are not affected. Patients become physically less active than referents. The role of seizures for this difference is unclear and other medical and social factors should be considered.

Socioeconomic prognosis after a newly diagnosed unprovoked epileptic seizure in adults: a population-based case-control study

PURPOSE

To investigate the socioeconomic prognosis after a newly diagnosed unprovoked epileptic seizure in adults.

METHODS

Sixty-three patients 17 years or older with a newly diagnosed unprovoked epileptic seizure from 1985 through 1987 and 107 sex- and age- matched controls were followed up for 10 years to 1996. Studied variables were income, source of income, sickness periods, incapacity rate, diagnosis-specific incapacity rate, vocational status, and education.

RESULTS

Relative growth of income was similar between patients and controls during follow-up. Patients had lower income than did controls 2 years before seizure onset and during the entire follow-up. This was related to higher morbidity among patients, as measured by sickness periods and incapacity rate. Employment rates did not evolve negatively among patients after seizure onset and were close to employment rates of controls during follow-up time. There was no difference between patients and controls regarding education.

CONCLUSIONS

After a newly diagnosed unprovoked epileptic seizure in adults, no negative development regarding employment and education occurs. Income development is positive unless refractory seizures evolve. However, income is lower among patients with epilepsy than among controls, and this difference can be related to overall morbidity.

Seizure-induced damage in the developing human: relevance of experimental models

A considerable amount of money and effort is spent every year investigating the effects of seizure on the developing rodent brain. A critical question is the relevance of these studies to children. The goal of this chapter is to review the relationship between seizures during early development and cognitive impairment in children and rodents. While the majority of children with epilepsy have normal cognitive development, a small group of children with frequent, recurrent seizures show progressive cognitive impairment. Likewise, in rodent models recurrent seizures during early development are associated with cognitive impairment and histological changes including mossy fiber sprouting and reduced neurogenesis. Status epilepticus is associated with a lower morbidity and mortality rate in children than in adults. Status epilepticus in rodent models is associated with less cell loss and cognitive impairment than in adults. While rodent studies can offer a great deal of insight into mechanisms of seizure-induced brain damage, they also have significant limitations. No animal models have yet been developed that mimic human epileptic syndromes, such as infantile spasms, Lennox-Gastaut syndrome, or the severe myoclonic epilepsies. In addition, rodent studies supply only crude measures of learning and memory. Disturbances of language or higher cortical functions such as visual or auditory processing cannot be tested in animal models.