Risk Factors in Childhood Intractable Epilepsy

Doğan Öncü; Ayşe Aysima Özçelik; Saliha Seda Adanır

doi:10.5152/eurjther.2021.20003

Authors

Doğan Öncü Department of Pediatric Neurology, Gaziantep University School of Medicine, Gaziantep, Turkey https://orcid.org/0000-0001-9068-3789
Ayşe Aysima Özçelik 1Department of Pediatric Neurology, Gaziantep University School of Medicine, Gaziantep, Turkey https://orcid.org/0000-0002-9567-4176
Saliha Seda Adanır Department of Anatomy, Gaziantep University School of Medicine, Gaziantep, Turkey https://orcid.org/0000-0002-9098-5194

DOI:

https://doi.org/10.5152/eurjther.2021.20003

Keywords:

Epilepsy, intractable epilepsy, intractable childhood, risk factor

Abstract

Objective: Intractable epilepsy is defined as a continuation of a seizure although antiepileptic drugs prescribed in accordance with the seizure type has been administered with adequate timing and dosage. Factors such as sex, age at onset of the seizure, family history, previous febrile seizure, mental and motor retardation, type of seizure, electroencephalography, and abnormal findings in neuroradiological imaging may cause resistance in treating epilepsy. Determining the risk factors of intractable epilepsy may be useful in the early diagnosis, prognosis, and treatment of the disease. This study aimed to determine the possible risk factors for the development of intractable epilepsy. Methods: A questionnaire was completed face to face by the families of 210 patients with childhood epilepsy who applied to the Department of Child Neurology, Gaziantep University School of Medicine between January 2018 and September 2018 and were followed up. Data analysis was performed to determine the risk rates for the development of intractable epilepsy. Results: Early-seizure onset, abnormal neurological examination, microcephaly, symptomatic and cryptogenic epilepsy, electroencephalography abnormality, pathology, and specific epileptic syndrome were found to be the effective risk factors for the development of intractable epilepsy. Conclusion: The lack of the clear understanding of the definition of intractable epilepsy in the literature and the inability to clearly define its limits lead to contradicting results on the risk factors for it. Determining the exact criteria to evaluate the risk of developing intractable epilepsy in future studies and patient follow-up will guide the diagnosis, treatment, and prognosis of patients with intractable epilepsy.

Metrics

Metrics Loading ...

References

Chuang NA, Otsubo H, Chuang SH. Magnetic resonance imaging in pediatric epilepsy. Top Magn Reson Imaging 2002; 13: 39-60.

Appleton R, Demellweek C. Post-traumatic epilepsy in children requiring inpatient rehabilitation following head injury. J Neurol Neurosurg Psychiatry 2002; 72: 669-72.

Rocca WA, Sharbrough FW, Hauser WA, Annegers JF, Schoenberg BS. Risk factors for complex partial seizures: a population‐based case‐control study. Ann Neurol 1987; 21: 22-31.

Berg AT. Defining intractable epilepsy. Adv Neurol 2006; 97: 5-10.

French JA. Refractory epilepsy: one size does not fit all. Epilepsy Curr 2006; 6: 177-80.

Berg AT, Shinnar S, Levy S, Testa F, Smith-Rapaport S, Beckerman B. Early development of intractable epilepsy in children: a prospective study. Neurology 2001; 56: 1445-52.

Aneja S, Jain P. Refractory epilepsy in children. Indian J Pediatr 2014; 81: 1063-72.

Fang PC, Chen YJ, Lee IC. Seizure precipitants in children with intractable epilepsy. Brain Dev 2008; 30: 527-32.

Banerjee PN, Filippi D, Hauser WA. The descriptive epidemiology of epilepsy-a review. Epilepsy Res 2009; 85: 31-45.

Berg AT, Levy SR, Novotny EJ, Shinnar S. Predictors of intractable epilepsy in childhood: a case‐control study. Epilepsia 1996; 37: 24-30.

Berg AT, Kelly MM. Defining intractability: comparisons among published definitions. Epilepsia 2006; 47: 431-6.

Gururaj A, Sztriha L, Hertecant J, Eapen V. Clinical predictors of intractable childhood epilepsy. J Psychosom Res 2006; 61: 343-7.

Kwan P, Brodie MJ. Early identification of refractory epilepsy. N Engl J Med 2000; 342: 314-9.

Malik MA, Hamid MH, Ahmed TM, Ali Q. Predictors of intractable childhood epilepsy. J Coll Physicians Surg Pak 2008; 18: 158-62.

Kwong KL, Sung WY, Wong SN, So KT. Early predictors of medical intractability in childhood epilepsy. Pediatr Neurol 2003; 29: 46-52.

Ohtsuka Y, Yoshinaga H, Kobayashi K. Refractory childhood epilepsy and factors related to refractoriness. Epilepsia 2000; 41: 14-7.

Chawla S, Aneja S, Kashyap R, Mallika V. Etiology and clinical predictors of intractable epilepsy. Pediatr Neurol 2002; 27: 186-91.

Huang L, Li S, He D, Bao W, Li L. A predictive risk model for medical intractability in epilepsy. Epilepsy Behav 2014; 37: 282-6.

Yilmaz BS, Okuyaz C, Komur M. Predictors of intractable childhood epilepsy. Pediatr Neurol 2013; 48: 52-5.

Moinuddin A, Rahman M, Akhter S, Kawser C. Predictors of Childhood Intractable Epilepsy-A Retrospective Study in A Tertiary Care Hospital. Bangladesh J Child Health 2009; 33: 6-15.

Ko TS, Holmes GL. EEG and clinical predictors of medically intractable childhood epilepsy. Clin Neurophysiol 1999; 110: 1245-51.

Berg AT, Vickrey BG, Testa FM, Levy S, Shinnar S, DiMario F, et al. How long does it take for epilepsy to become intractable? A prospective investigation. Ann Neurol 2006; 60: 73-9.

Cansu A, Serdaroğlu A, Yüksel D, Doğan V, Özkan S, Hırfanoğlu T, et al. Prevalence of some risk factors in children with epilepsy compared to their controls. Seizure 2007; 16: 338-44.

Brodie MJ, Leach JP. Success or failure with antiepileptic drug therapy: Beyond empiricism? Neurology 2003; 60: 162-3.

Sillanpää M. Remission of seizures and predictors of intractability in long‐term follow‐up. Epilepsia 1993; 34: 930-6.

Saygi S, Erol I, Alehan F. Early clinical predictors of intractable epilepsy in childhood. Turk J Med Sci 2014; 44: 490-5.

Wirrell E, Wong‐Kisiel L, Mandrekar J, Nickels K. Predictors and course of medically intractable epilepsy in young children presenting before 36 months of age: A retrospective, population‐based study. Epilepsia 2012; 53: 1563-9.

Tripathi M, Padhy UP, Vibha D, Bhatia R, Srivastava MV, Singh MB, et al. Predictors of refractory epilepsy in North India: A case-control study. Seizure 2011; 20: 779-83.

Russo A, Posar A, Conti S, Parmeggiani A. Prognostic factors of drug‐resistant epilepsy in childhood: An Italian study. Pediatr Int 2015; 57: 1143-8.

Sidenvall R, Heijbel J, Blomquist H, Nyström L, Forsgren L. An incident case-control study of first unprovoked afebrile seizures in children: a population‐based study of pre‐and perinatal risk factors. Epilepsia 2001; 42: 1261-5.

Daoud A, Batieha A, Bashtawi M, El-Shanti H. Risk factors for childhood epilepsy: a case-control study from Irbid, Jordan. Seizure 2003; 12: 171-4.

Udani V, Dharnidharka V, Nair A, Oka M. Difficult to control epilepsy in childhood--a long term study of 123 cases. Indian Pediatr 1993; 30: 1199-206.

Huttenlocher PR, Hapke RJ. A follow‐up study of intractable seizures in childhood. Ann Neurol 1990; 28: 699-705.

Ohtsuka Y, Yoshinaga H, Kobayashi K, Murakami N, Yamatogi Y, Oka E, et al. Predictors and underlying causes of medically intractable localization-related epilepsy in childhood. Pediatr Neurol 2001; 24: 209-13.