DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20192624

Risk factors for childhood refractory epilepsy in a tertiary care centre, Chennai, India

Thannoli Gowthami Gowrinathan, Senthil Kumar A.

Abstract


Background: Intractable epilepsy is the pragmatic problem during the treatment of active epilepsy in children. Several risk factors are associated with incidence of intractable/recurrent epilepsy. The current study was done to identify the risk and prognostic factors associated with recurrent epilepsy (RE).

Methods: This descriptive study was conducted on 152 children with idiopathic or symptomatic epilepsy who are on two or more AEDs and who were in follow up in Neurology OPD and inpatients in medical ward at ICH&HC, Chennai. All patients underwent relevant investigations to identify the possible risk factors for incidence of RE in study population. Karyotyping was done for idiopathic cases.

Results: Male preponderance was seen in the study (M:F-2:1). Risk factors such as male sex, age onset of seizures, type of seizures, developmental delay, CNS congenital anomalies, h/o perinatal injury, neuroabnormality, abnormal MRI and EEG was found to have statistically significant association with incidence of RE. No significant association was observed for the factors microcephaly, behavioural abnormalities, h/o febrile seizures and h/o status epilepticus with incidence of RE. No chromosomal abnormalities were detected in idiopathic cases.

Conclusions: Early identification, risk factor analysis and understanding in the dynamics of the disease helps the physician in initiating the appropriate treatment, thereby avoiding the wrong therapy, low dose therapy and infrequent therapy. Above all identification of the risk factors helps in parental counseling and prepare them for expected outcome.


Keywords


Children, Intractable epilepsy, Risk factors

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References


Forsgren L. Incidence and prevalence. In: Wallace SJ, Farrell K, Eds. Epilepsy in children. 2nd Ed. Arnold, London;2004:21-25.

Yilmaz BS, Okuyaz C, Komur M. Predictors of Intractable Childhood Epilepsy. Paediatr Neurol. 2013;48(1):52-5.

Arts WF. Brouwer OF, Peters AC, Stroink H, Peeters EA, Schmitz PI, et al. Course and prognosis of childhood epilepsy: 5-year follow-up of the Dutch Study of Epilepsy in Childhood. Brain. 2004;127(Pt 8):1774-84.

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

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

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

Dalic L, Cook MJ. Managing drug-resistant epilepsy: challenges and solutions. Neuropsychiatr Dis Treat. 2016;12:2605-16.

Akhondian J, Heydarian F, Jafari SA. Predictive factors of pediatric intractable seizures. Arch Iran Med. 2006;9:236-9.

Berg AT, Levy SR, Testa FM, Shinnar S. Treatment of newly diagnosed pediatric epilepsy : a community-based study Arch pediatr Adolesc Med. 1999;153:1267-71.

Malik MA, Hamid MH, Ahmed TM, Ali Q. Predictors of Intractable Childhood Epilepsy. J College Phy Surg Pak. 2008;18(3):158-62.

Udhani V. Paediatric Epilepsy- An Indian Perspective. Indian J Paeditr. 2005;72:309-13.

Datta SS, Premkumar TS, Chandy S, Kumar S, Kirubakaran C, Gnanamuthu C, et al. Behaviour problems in children and adolescents with seizure disorder: Associations and risk factors. Seizure. 2005;14:190-7.

Tripathi M, Vibha D, Bhatia R, Srivastava MVP, Singh MB, et al. Predictors of refractory epilepsy in North India: A case–control study. Seizure. 2011;20(10):779-83.

Hauser WA. The prevalence and incidence of convulsive disorders in children. Epilepsia. 1994;35(2):1-6.

Mulley JC, Mefford HC. Epilepsy and the new cytogenetics. Epilepsia. 2011;52(3):423-32.