Prevalence, classification, and severity of epilepsy in children in western Norway

Incidencia de la epilepsia infantil

OBJECTIVE

To calculate the annual incidence rate of epilepsy, as well as the relative distribution of the different forms of epilepsy and epileptic syndromes in infants and children.

PATIENTS AND METHODS

All incident cases in infants and children aged less than 15 years living in Navarre (Spain) with newly diagnosed epilepsy (2002 to 2005) were prospectively registered. Epidemiological and clinical data and the results of complementary investigations were recorded. The criteria for epileptic seizures and epileptic syndromes of the International League Against Epilepsy (ILAE) and the ILAE guidelines for epidemiological studies were applied.

RESULTS

One hundred ninety-nine patients were diagnosed with childhood epilepsy (22 infants, 66 young children, 54 school children and 49 adolescents). The annual incidence rate was 62.6 cases per 100,000 (95 % CI: 62.3-62.9). The incidence rate was highest during the first year of life (95.3 per 100,000) and gradually decreased until adolescence (48.7/100,000). Focal epilepsy was found in 55 %, generalized epilepsy in 42.9 %, and undetermined epilepsy in 2.1 %. In infants, the most prevalent epileptic syndromes were West syndrome (45.5 %), epilepsies associated with specific syndromes (27.5 %), and focal symptomatic epileptic syndromes (13.6 %). In early childhood, the main syndromes were focal symptomatic epilepsy (22.7 %), cryptogenic epilepsy (21.2 %), and Doose syndrome (13.6 %). In schoolchildren, the most frequent syndromes were focal benign epilepsies (27.8 %), cryptogenic epilepsy (18.5 %), and absence epilepsy (18.5 %). In adolescents, the most frequent syndromes were focal cryptogenic epilepsies (27.6 %) and benign epilepsies (18.4 %).

CONCLUSIONS

The annual incidence rate of epilepsy in infants and children in Navarre is similar the rates described for other western countries, with the highest incidence rate being found during the first year of life and gradually diminishing until adolescence. Published data concerning the relative frequency of epilepsy and epileptic syndromes are discordant. These discrepancies highlight the difficulty of establishing a syndromic diagnosis in this age group and the need to apply uniform criteria in order to obtain valid and comparable epidemiological data.

Preventable and unpreventable causes of childhood-onset epilepsy plus mental retardation

OBJECTIVE

The objective of this study was to determine the causes of childhood epilepsy associated with mental retardation and determine whether these causes are preventable.

METHODS

We selected all patients from the Nova Scotia population-based childhood epilepsy cohort (n = 692) who had mental retardation and had epilepsy onset between 1977 and 1985. Causes and family history were determined by chart review and caregiver interview after 18.8 (SD: +/-7) years of follow-up.

RESULTS

Overall, 147 patients had mental retardation and epilepsy (21% of all childhood epilepsy). Standard psychological testing was available for 57%; 38.5% were too impaired for testing, which left 4% with the degree of mental retardation assessed clinically. Severe/profound mental retardation predominated (mild: 24%; moderate: 23%, severe/profound: 53%). Fifty-nine percent had additional severe neurologic deficits, most often associated with severe mental retardation. Epilepsy syndromes were symptomatic generalized (n = 73), partial (n = 58), and other (n = 16). Most had a brain imaging study: 91% had a computed tomography scan, and 12% had an MRI scan. Sixty-three percent had a defined cause; 37% had an unknown cause. A defined cause was more likely in those with severe mental retardation (60 of 78 vs 31 of 65). Identified causes were prenatal or genetic (65%), perinatal (8%), or complications of prematurity (13%). Only 11 (7%) had an acquired cause that was potentially preventable. Many (36%) had a first- or second-degree relative with epilepsy, more often in those without a clear cause (54% vs 30%) and without additional neurologic disability (57% vs 26%).

CONCLUSIONS

Approximately 20% of children with epilepsy have mental retardation. The cause is prenatal or genetic in nearly two thirds, and only 7% have an acquired, preventable cause. Important genetic influences may be present, especially in the absence of a defined cause.

Epilepsy in children in Navarre, Spain: epileptic seizure types and epileptic syndromes

Data for children 1 month to 15 years of age at the time of diagnosis of epilepsy were recorded from the children's hospital "Virgen del Camino" in Pamplona (Spain) from January to December 2005. International League Against Epilepsy criteria were used for diagnoses. A total of 365 children were recruited into the study. Mean age at diagnosis was 5.97 years, and time of follow-up was 4.6 years. Etiology was idiopathic in 166 (45.5%), cryptogenic in 106 (29.0%), and symptomatic in 93 (25.5%). Focal seizures were seen in 52.9% of the patients, generalized epilepsy in 43.5%, and 3.6% were not determined. In infants, West syndrome (34.1%) and focal symptomatic seizures (24.4%) were the most prevalent syndromes. In early childhood, the main syndromes were cryptogenic focal epilepsies (17.7%) and Doose syndrome (12.8%). In school-aged children, benign epilepsies (27.3%) and absences (24.5%) were prevalent. In adolescents, cryptogenic focal epilepsies (26.6%) and benign epilepsies (23.4%).

Cryptogenic localization related epilepsy in children from a tertiary outpatient clinic: Is neurological and neuropsychological outcome predictable?

OBJECTIVES

Up to one-third of the children with epilepsy are diagnosed with cryptogenic localization related epilepsy (CLRE). As yet, there is a lack of studies that specify the short- and long-term prognosis for this group. In this study, we systematically established neurological outcome (represented by seizure frequency) as well as neuropsychological outcome in a cohort of 68 children with CLRE who had been referred to our tertiary outpatient clinic. Also, we analysed correlations with risk and prognostic factors.

PATIENTS AND METHODS

A systematic cross-sectional open clinical and non-randomized design was used including 68 children admitted to our epilepsy centre in a child neurological programme between January 1999 and December 2004. A model was defined, distinguishing risk factors with a potential effect on epileptogenesis (history of febrile seizures, family history of epilepsy, history of early mild development delay and serious diagnostic delay) and prognostic factors, with a potential effect on the course of the epilepsy (neurological symptoms or soft signs, age at onset, duration of epilepsy, seizure type, percentage of time with epileptiform activity, localization of epileptiform activity, treatment history and treatment duration). Seizure frequency was used as the primary outcome variable, whereas three neuropsychological outcomes (IQ, psychomotor delay and educational delay) were used as secondary outcome variables.

RESULTS

The children experienced a broad range of seizure types with the 'absence-like' complex partial seizure as the most commonly occurring seizure type. Almost half of the children of the study sample had a high seizure frequency. They experienced several seizures per month, week or even daily seizures. Also a substantial impact on neuropsychological outcome was observed. Mean full scale IQ was 87.7, mean academic delay was almost 1 school year and 27 children showed psychomotor delay on the Movement ABC. Only 'having more than one seizure type' showed a prognostic value for seizure frequency, and no factors were found to be correlated with the secondary outcome measures. None of the risk factors show a differential impact on seizure outcome.

CONCLUSION

CLRE has a non-predictable course; clinical variability is high and prognosis in many children with CLRE is obscure. Having more than one seizure type was the only factor correlated to seizure frequency. Further longitudinal studies are needed.

Temperament and character factors in Korean children with seizure disorders

Although the organic and psychosocial consequences of seizure disorders are thought to affect temperament and character patterns, these patterns in children with seizure disorders have not yet been investigated. We therefore investigated temperament and character patterns in Korean children with seizure disorders and their associations with seizure-related variables. The Korean version of the Junior Temperament and Character Inventory was used to assess temperament and character factors of 65 children with seizure disorders (32 boys, 33 girls; mean age, 10.6 +/- 1.8 years) and 65 healthy controls matched for age and sex. Children with seizure disorders showed higher harm avoidance, and lower persistence, self-directedness, and cooperativeness than controls. In children with seizure disorders, character factors such as self-directedness, cooperativeness, and self-transcendence were significantly associated with seizure type, and cooperativeness was correlated with seizure severity. Novelty seeking and self-directedness were correlated with paternal educational level and parental economic status, respectively. These findings suggest that children with seizure disorders have distinctive temperament and character patterns, with seizure type being the most influential factor modulating character patterns.

Health-related quality of life in youth with epilepsy: Theoretical model for clinicians and researchers. Part I: The role of epilepsy and co-morbidity

Children and adolescents with epilepsy are at increased risk for poor health-related quality of life (HRQL) even in the absence of active seizures. Clinicians who aim to achieve optimal seizure control also need to focus on improving HRQL. This can only be accomplished by recognizing how different features of the epilepsy itself, co-morbid conditions, as well as psychosocial factors can all make a difference to HRQL. These psychosocial factors include child, family and community/society variables that play a role in the well-being of these children. Conceptual models are relevant insofar as they provide us with a basis for hypothesizing the causal processes that lead to improved HRQL. They delineate what is meant by HRQL and highlight factors relevant to this important outcome. Researchers can use such models to test statistically and clinically relevant relationships. Clinicians can use this knowledge to direct the planning and implementation of services that are informed by these relationships, critically evaluate and then choose HRQL measures for use in clinical practice that most closely approximate what they understand HRQL is. The purpose of this review is to identify what is meant by HRQL as well as outline the theoretical and empirical basis for what it is about epilepsy, co-morbidity, and its treatment that we believe make a difference to HRQL.

Psychiatric symptoms in adolescents with epilepsy in junior high school in Norway: a population survey

The aims of this study were to assess the frequency and impact of psychiatric symptoms among adolescents with epilepsy in a general population, and compare the findings with those for adolescents without epilepsy. The data were collected through the Health Profiles for Children and Youth in Akershus Study. The data were cross-sectional and based on self-reports from adolescents (13-16 years of age). To assess psychiatric symptoms, we used the Strengths and Difficulties Questionnaire-Self Report (SDQ-S). A total of 11,021 pupils were invited to participate, and 9424 responded to the questionnaire (response rate=86%). We found that adolescents with epilepsy (124) from an unselected group obtained a significantly higher symptom score on the SDQ-S than those without epilepsy, indicating a higher incidence of psychiatric symptoms. The adolescents with epilepsy also reported a greater impact of their perceived difficulties on their daily life than did adolescents without epilepsy. The study illustrates the need for developing better strategies to detect and prevent psychiatric problems in adolescents with epilepsy.

Cryptogenic localization-related epilepsy with childhood onset: The problem of definition and prognosis

BACKGROUND

Up to one-third of children with epilepsy are diagnosed with cryptogenic localization-related epilepsy (CLRE). CLRE is a large nonspecific category within the ILAE classification. For this population no unequivocal prognosis exists.

METHODS

Twenty-five articles describing aspects of CLRE were included in this review.

RESULTS

As a result of the progress in epilepsy research, as well as more advanced investigation in individual cases, the population with CLRE constantly changes. Also, disagreement on interpretation of the classification has resulted in striking differences between the populations described. High remission rates are reported, but relapse occurs frequently, leaving the long-term prognosis unforeseeable. This is reflected in academic and psychosocial prognosis, which is described to be problematic in CLRE specifically. Possible prognostic factors of CLRE in children have been identified: age at onset, seizure semiology, seizure frequency, intractability, interictal epileptiform activity on EEG, and premorbid IQ. These factors are explored to define subgroups within the CLRE population.

DISCUSSION

Prospective studies on well-defined CLRE cohorts are needed to identify factors that distinguish various prognostic subgroups. Specific attention should be focused on course of the epilepsy, scholastic achievement, and psychosocial outcome.

A population based study of epilepsy in children from a Swedish county

BACKGROUND

Epidemiological studies of childhood epilepsy are of importance to compare incidence and prevalence rates, age distribution, inheritance, seizure types, epilepsy syndromes and treatment strategies.

AIM

To perform an epidemiological study on children with epilepsy in a Swedish county using current ILAE classifications and a recent proposal.

METHODS

A population-based study was performed using the hospital data register to select children aged 1 month to 16 years with the diagnosis 'convulsions' or 'epilepsy' recognized between January 1996 and December 2000. Only patients with active epilepsy were included.

RESULTS

Two hundred and five children met the study criteria on the prevalence day 31st December, 2000. The total prevalence rate was 3.4/1,000 with a peak prevalence in the age group 8-11 years. The incidence year 2000 was 40/100,000. Additional neuroimpairments were registered in 47.3%. A majority of the patients, 54.0%, had focal or focal plus secondarily generalized seizures. A named syndrome could be diagnosed in 49.4%. The most common syndrome was rolandic epilepsy occurring in 17.0%. Childhood absence epilepsy occurred in 5.9%. Different disorders associated with epilepsy were found in 31.7%. The most common associated phenomenon was malformation of cortical development. Antiepileptic drug treatment was used in 81.0%, the most common first choice being valproate.

CONCLUSIONS

The prevalence and incidence rates in this strictly delineated study are lower than those found in other epidemiological studies. Together with many divergences between reported studies concerning frequencies of different items, the results apparently depend on design, e.g. differences in age groups included, inclusion criteria used, and general methodology.

Prevalence of Childhood Epilepsy and Distribution of Epileptic Syndromes: A Population-based Survey in Okayama, Japan

PURPOSE

A population-based survey childhood epilepsy was undertaken in Okayama Prefecture, Japan, to determine the prevalence rate and the distribution of epilepsies and epileptic syndromes according to the International Classification (ILAE, 1989).

METHODS

Information on patients younger than 13 years with active epilepsy was collected from medical records. Patients diagnosed with epilepsy according to clinical and EEG findings were put on the list even if those patients had had a single seizure or seizures occurring during febrile episodes.

RESULTS

In total, 2,220 cases were identified from a background population of 250,997. The prevalence rate was 8.8 per 1,000. If we exclude patients who had experienced a single seizure or seizures occurring during febrile episodes to compare our results with previous reports, the prevalence rate was 5.3 per 1,000. Of the 2,220 cases, 2,030 (91.4%) were classified into three major categories by ILAE classification. They consisted of 1,556 (76.7%) with localization-related epilepsy, 453 (22.3%) with generalized epilepsy, and 21 (1.0%) with undetermined epilepsy. Of the 2,030 cases, 309 (15.2%) were classified into epileptic syndrome categories, and 84.8% of the total were nonspecific types of epilepsy.

CONCLUSIONS

The prevalence rate of childhood epilepsy was distributed from 5.3 to 8.8 per 1,000. The appearance rate of various types of epileptic syndromes was low. Most cases could not be classified into the detailed categories of the International Classification (ILAE, 1989).

Psychosocial problems and seizure-related factors in children with epilepsy

In this study we describe psychosocial functions and seizure-related factors in a population-based sample of children with epilepsy. Psychosocial problems (Achenbach scales), cognitive function, and socioeconomic status were studied in 117 children with epilepsy aged between 6 and 13 years (mean age 11y [SD 2y 1mo] and 10y 8mo [SD 2y]; 71 males, 46 females) and in randomly selected controls matched with 117 children for sex and age (mean age 11y 2mo [SD 2y 1mo] and 10y 5mo [SD 2y 4mo]; 69 males, 48 females). The children had partial (n=67), generalized (n=43), or undetermined (n=7) epilepsy syndromes, and partial (n=68), generalized (n=47), or other (n=2) main seizure types. Psychosocial problems were more common among children with epilepsy than controls (odds ratio 5-9) and significantly related to epilepsy syndrome, main seizure type, age at onset, and seizure frequency. Mothers and teachers reported males with epilepsy as having more problems than females. Females self-reported psychosocial problems, males did not. Psychosocial problems were common in childhood epilepsy. Females appreciated the problems more realistically than males. Psychosocial problems should be considered an integral part of epilepsy management.

Epidemiology of idiopathic generalized epilepsies

Idiopathic generalized epilepsies (IGEs) are a relatively new category of disorders defined by strict clinical and electroencephalogram (EEG) features proposed by the International League Against Epilepsy (ILAE) classification of epileptic syndromes. IGEs are usually easy to diagnose when clinical and EEG data are collected, but epilepsy is not synonymous with epileptic syndrome. So far, IGEs are studied in the large group of epilepsies of undetermined or unknown etiology although the genetic origin is now largely accepted. ILAE-proposed criteria are helpful in the clinical and therapeutic management of IGEs, but many epidemiologic studies still confuse the cryptogenic and idiopathic groups. Some syndromes in childhood, which are completely described by strict electroclinical criteria such as the absence epilepsies, juvenile myoclonic epilepsies, are usually included and analyzed in epidemiologic studies; however, other epileptic syndromes observed in infancy, such as benign familial neonatal seizures and benign myoclonic epilepsy in infancy, are quite rare and are usually excluded from epidemiologic surveys because they are difficult to describe completely in electro-clinical terms. Another strong limitation in the study of epidemiology of IGEs is the lack of EEG data, either because EEG is not available or the routine EEG is normal. This is particularly relevant in the inclusion of patients with only tonic-clonic seizures. IGEs encompass several different syndromes, and a few patients shift from one phenotype to another. The overlapping of some syndromes during infancy and adolescence increased the difficulty to individualize strictly the correct syndrome. Many discrepancies can be observed in the distribution of the different syndromes included in the group of IGEs, because the strict criteria for classifying these syndromes proposed by the ILAE are often not respected. With this understanding, the general frequency of IGEs can be assessed at 15-20% of all epilepsies. The frequency and the distribution of incidence and prevalence of the different syndromes are tentatively reported and discussed. When the term idiopathic is used following the restrictive ILAE criteria, the mortality data concerning patients with idiopathic epilepsies do not show an increased standardized mortality ratio.

Seizure-related factors and non-verbal intelligence in children with epilepsy. A population-based study from Western Norway

PURPOSE

To study the relationship between seizure-related factors, non-verbal intelligence, and socio-economic status (SES) in a population-based sample of children with epilepsy.

METHODS

The latest ILAE International classifications of epileptic seizures and syndromes were used to classify seizure types and epileptic syndromes in all 6-12 year old children (N=198) with epilepsy in Hordaland County, Norway. The children had neuropediatric and EEG examinations. Of the 198 patients, demographic characteristics were collected on 183 who participated in psychological studies including Raven matrices. 126 healthy controls underwent the same testing. Severe non-verbal problems (SNVP) were defined as a Raven score at or <10th percentile.

RESULTS

Children with epilepsy were highly over-represented in the lowest Raven percentile group, whereas controls were highly over-represented in the higher percentile groups. SNVP were present in 43% of children with epilepsy and 3% of controls. These problems were especially common in children with remote symptomatic epilepsy aetiology, undetermined epilepsy syndromes, myoclonic seizures, early seizure debut, high seizure frequency and in children with polytherapy. Seizure-related characteristics that were not usually associated with SNVP were idiopathic epilepsies, localization related (LR) cryptogenic epilepsies, absence and simple partial seizures, and a late debut of epilepsy. Adjusting for socio-economic status factors did not significantly change results.

CONCLUSIONS

In childhood epilepsy various seizure-related factors, but not SES factors, were associated with the presence or absence of SNVP. Such deficits may be especially common in children with remote symptomatic epilepsy aetiology and in complex and therapy resistant epilepsies. Low frequencies of SNVP may be found in children with idiopathic and LR cryptogenic epilepsy syndromes, simple partial or absence seizures and a late epilepsy debut. Our study contributes to an overall picture of cognitive function and its relation to central seizure characteristics in a childhood epilepsy population and can be useful for the follow-up team in developing therapy strategies that meet the individual needs of the child with epilepsy.

The epidemiology of epilepsy in Europe - a systematic review

Population-based epidemiological studies on epilepsy are available mainly from the UK and the Nordic, Baltic and western Mediterranean countries. No studies were identified from large areas of Europe, especially from the former eastern Europe (except the Baltic countries) and the eastern Mediterranean countries. Based on the prevalence of epilepsy in different studies and accounting for incomplete case identification the estimated number of children and adolescents in Europe with active epilepsy is 0.9 million (prevalence 4.5-5.0 per 1000), 1.9 million in ages 20-64 years (prevalence six per 1000) and 0.6 million in ages 65 years and older (prevalence seven per 1000). Approximately 20-30% of the epilepsy population have more than one seizure per month. Based on the age-specific incidence rates in European studies, the estimated number of new cases per year amongst European children and adolescents is 130,000 (incidence rate 70 per 100,000), 96,000 in adults 20-64 years (incidence rate 30 per 100,000) and 85,000 in the elderly 65 years and older (incidence 100 per 100,000). The proportion of both new and established cases with epilepsy in the young, adults and elderly in individual countries may differ substantially from total European distribution because of differences in age structure.

Learning disability: occurrence and long-term consequences in childhood-onset epilepsy

This study analyzed the occurrence of learning disability (LD) in adults with childhood-onset epilepsy and the impact of LD on medical and social outcome. Any LD occurred in 76%: in 57% of mentally normal (IQ>85), in 67% of mentally near-normal (IQ=71-85), and, self-evidently, in all mentally retarded (IQ<71) adults. Half of the patients (51%) with LD had mental retardation. In multivariate analysis, mental retardation and subsequent LD were predicted by occurrence of cerebral palsy (odds ratio [OR]=3.83; 95% confidence interval [CI]=1.77-8.28, P=0.0006), onset of epilepsy before the age of 6 years (OR=3.63, 95% CI=1.57-8.42, P=0.0026), and poor early effect of drug therapy (OR=2.78, 95% CI=1.43-5.39, P=0.0025). Among mentally normal or near-normal subjects, a symptomatic etiology of epilepsy was the only predictor (OR=7.72, 95% CI=3.02-19.76). The degree of LD significantly affected medical, social, and educational long-term outcomes.

Defining the problem: psychiatric and behavioral comorbidity in children and adolescents with epilepsy

A variety of comorbid psychiatric conditions are frequently identified in children and adolescents with epilepsy, including depression, anxiety, psychosis, and attention-deficit hyperactivity disorder. Data regarding the epidemiology and precise prevalence of comorbid disorders in childhood epilepsy are incomplete and just now beginning to be compiled. Psychiatric and behavioral comorbidities are believed to affect approximately 40-50% of children and adolescents with epilepsy. Optimal diagnosis, clinical evaluation, and choice of treatment are predicated on the proper identification of coexisting psychiatric and behavioral disorders. Comorbid conditions in children and adolescents with epilepsy should be evaluated and treated as soon as they are recognized.

Specific Epileptic Syndromes Are Rare Even in Tertiary Epilepsy Centers: A Patient‐oriented Approach to Epilepsy Classification

PURPOSE

To assess the practicability and reliability of a five-dimensional patient-oriented epilepsy classification and to compare it with the International League Against Epilepsy (ILAE) classification of epilepsy and epileptic syndromes. The dimensions consist of the epileptogenic zone, semiologic seizure type(s), etiology, related medical conditions, and seizure frequency.

METHODS

The 185 epilepsy patients (94 adults, 91 children, aged 18 years or younger) were randomly selected from the database of a tertiary epilepsy center and the general neurological department of a metropolitan hospital (28 adults). The charts were reviewed independently by two investigators and classified according to both the ILAE and the patient-oriented classification. Interrater reliability was assessed, and a final consensus among all investigators was established.

RESULTS

Only four (4%) adults and 19 (21%) children were diagnosed with a specific epilepsy syndrome of the ILAE classification. All other patients were in unspecific categories. The patient-oriented classification revealed that 64 adults and 56 children had focal epilepsy. In an additional 34 adults and 45 children, the epileptogenic zone could be localized to a certain brain region, and in 14 adults and five children, the epileptogenic zone could be lateralized. Fourteen adults and 21 children had generalized epilepsy. In 16 adults and 14 children, it remained unclear whether the epilepsy was focal or generalized. Generalized simple motor seizures were found in 66 adults and 52 children, representing the most frequent seizure type. Etiology could be determined in 40 adults and 45 children. Hippocampal sclerosis was the most frequent etiology in adults (10%), and cortical dysplasia (9%), in children. Seven adults and 31 children had at least daily seizures. Seventeen adults and 26 children had rare or no seizures at their last documented contact. The most frequent related medical conditions were psychiatric disorders and mental retardation. Interrater agreement was high (kappa values of 0.8 to 0.9) for both the patient-oriented and the ILAE classification.

CONCLUSIONS

Specific epilepsy syndromes included in the current ILAE classification are rare even in a tertiary epilepsy center. Most patients are included in unspecific categories that provide only incomplete information. In contrast, all of the patients could be classified by the five-dimensional patient-oriented classification, providing all essential information for the management of the patients with a high degree of interrater reliability.

Study of seizure and epilepsy in Chinese children in Hong Kong: period prevalence and patterns

The Hong Kong Children's Seizure and Epilepsy Registry was set up for all children with a history of seizures or epilepsy followed up in the Epilepsy Clinic of the University of Hong Kong. The aim was to study the pattern of seizures and epileptic disorders in Chinese children. The objective was to study the period prevalence of epilepsy and the pattern of epilepsy in Chinese children. A prospective study of seizure and epilepsy in Chinese children was conducted from 1985 to 1997 in Hong Kong. The population census of 1997 was used to calculate the period prevalence of epilepsy in Chinese children. Altogether, 1103 children aged < 19 years at first assessment with epilepsy were included in the study. The period prevalence rate of epilepsy in 1997 (January to December) is estimated to be 4.5 per 1000 children aged < 19 years. The estimated period prevalence rate of children and adolescents with epilepsy in our children is 4.5 per 1000 children.

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.

Use of complementary medicine in children with attention deficit hyperactivity disorder and epilepsy

We retrospectively studied use of complementary medicine in children with Attention Deficit Hyperactivity Disorder, epilepsy, and controls. Parents of patients with Attention Deficit Hyperactivity Disorder (n = 120; mean age 11.0 +/- 3.1 years), epilepsy (n = 115; 10.9 +/- 5.5), and healthy children seen in the emergency room during an acute illness (n = 115; 5.0 +/- 4.9) were individually interviewed regarding past and present use of complementary medicine. We found that 34 children with Attention Deficit Hyperactivity Disorder, 37 with epilepsy, and 24 controls had, at some time during their life, received complementary medicine: diet (n = 50), homeopathy (n = 46), acupuncture (n = 23), and biofeedback (n = 9). Current use was significantly less: Attention Deficit Hyperactivity Disorder- 7.5%, epilepsy-14%, and controls-7%. No differences among groups were found for either past use or method of complementary medicine employed. However, the most significant predictor for current use of complementary medicine was past use (OR 3.2, P < 0.001), followed by level of father's education (OR = 1.16, P = 0.01). There was a trend for more children with epilepsy (OR = 1.7) and children from religious families (OR = 1.51) to be currently receiving complementary medicine. In summary, only a small minority of patients with either Attention Deficit Hyperactivity Disorder or epilepsy used complementary medicine as part of their current medical regimen, although during their lifetime a third had received complementary medicine. Complementary medicine was more consistently used in children who had previously received complementary medicine, regardless of their medical diagnosis.

Epilepsy in mainstream and special educational primary school settings

This population based study compared the prevalence, nature and management of epilepsy between primary school children in mainstream education and those attending a special educational placement (children with special needs). The overall prevalence of epilepsy was 4.3/1000, but was 30 times higher in children with special needs, many of whom also had severe physical disabilities. Seizure types and the proportion of subjects with multiple seizures were similar in mainstream children and those with special needs. Epilepsy syndromes were identified in 74% of children. Although seizures were better controlled in children at mainstream school, 44% of these children did not have well controlled seizures. Children with epilepsy are an educationally vulnerable group and both education and health staff need to be aware of the additional support that many of these children require in all types of primary educational settings.

The epidemiology of the epilepsies in children

The epilepsies are a heterogeneous collection of neurological conditions and syndromes characterized by recurrent, unprovoked, paroxysmal seizure activity. There are several types of epileptic seizures and syndromes that are unique to children, including infantile spasms, Lennox-Gastaut syndrome and absence seizures. Febrile seizures and neonatal seizures, while not epilepsy, are relatively common types of seizures in infants and children and are likely markers of risk of later epilepsy. Thus, it is important to consider the epidemiological features of the epilepsies as they occur specifically in infants and children. The purpose of this review is to summarize what is currently known about the epidemiology of the childhood epilepsies and to identify promising areas for further population-based studies. The epilepsies are an important cause of neurological morbidity in children. The average annual rate of new cases (incidence) of epilepsy is approximately 5-7 cases per 10,000 children from birth to age 15 years, and in any given year, about 5 of every 1,000 children will have epilepsy. There is evidence that the incidence of the epilepsies in some populations of children may be decreasing over time, and this possibility merits further investigation. Factors that are known to increase risk of the epilepsies in children include congenital malformations of the central nervous system (CNS), moderate or severe head trauma, CNS infections, certain inherited metabolic conditions, and genetic factors. However, these account for only 25% to 45% of cases, and thus, the etiology of most cases of the epilepsies remains obscure. The paucity of well-controlled etiological studies is due largely to formidable methodological problems in conducting epidemiological studies of the epilepsies. The prognosis for seizure control is generally good, although children with remote symptomatic seizures and those with additional neurological disabilities do less well.

The prevalence of epilepsy amongst school children in Izmir, Turkey

OBJECTIVE

The aim of this study was to assess the prevalence of epilepsy among school children between the ages of 7-17 in Izmir province, in Turkey.

METHODS

A cross sectional study was conducted. Sample size is calculated as 4654, from the target population of 420054 students. A stratified random sampling technique was used to select the schools located in Izmir Metropolitan area. For the 130 (2.8%) students whose families gave a positive 'epilepsy history' a telephone interview was conducted in order to verify the diagnosis and to evaluate a etiological factors.

RESULTS

Response rate was 90.5% (4216 students). Out of the 130 students who had a positive epilepsy history, 47 (36.2%) were accepted as epilepsy 'cases'. The crude prevalence rates for females, males and the total study population were found respectively to the 11.3, 11.1 and 11.2 per thousand. Prevalence of active epilepsy rates for females, males and total study population were found respectively to be 4.5, 7.0 and 5.6 per thousand.

CONCLUSION

The prevalence of epilepsy is higher in school-age children in Izmir province compared to that in developed countries.

[Prevalence of epilepsy in Bakairi indians from Mato Grosso State, Brazil]

The purpose of this cross-sectional study was to evaluate the prevalence of epilepsy in a population based sample: the Bakairi indians, who live on the banks of Paranatinga river in the central plateau of Mato Grosso state, Brazil. This population is composed of 483 inhabitants. The study was outlined in two stages, and the investigation was door-to-door in a total of 103 houses. The results of the instrument showed a sensitivity of 88% (CI- 95%, 84.9-93), specificity of 97.8% (CI-95, 95-98). The prevalence of active epilepsy was 12.4 per mil, and inactive was 6.2 per mil. This prevalence of the epilepsy was considered high probably due to some familial risk factor (p=0.04) among those Indians, while other factors were not important.

Advances in our understanding of early childhood epilepsies: 1999-2000

Epilepsy is frequent in early childhood, but poorly understood. Management of very young children with refractory epilepsy is particularly challenging, but recent advances in classification, medical therapy, and surgical treatment are helping. We summarize work in each area, focusing on developments in the past 2 years. Classification schemes unique to the needs of very young children will likely improve our ability to accurately diagnose and treat those with refractory seizures. Medication studies are now being done that address some of the specific epilepsy syndromes seen in infants and young children, with promising results in some circumstances. Progress is also being made in the identification of good candidates for early, effective epilepsy surgery. For a variety of reasons and incentives, it is likely that research focusing on infants and young children will continue at a brisk pace.