Background

Focal onset epilepsy carries a higher risk of intractability than generalized onset epilepsy. Knowledge of the risk factors of intractability will help guide the treatment of children with focal epilepsy. In addition to risk factors present at initial diagnosis, the evolution of clinical and electroencephalographic features may also play a role in predicting intractability.

Methods

A prospective cohort study was done on children aged one month to three years with newly diagnosed focal epilepsy. Initial treatment of carbamazepine was given according to a standard protocol after assessment of clinical manifestations, neurologic and developmental status, EEG, and brain MRI. Depending on response to therapy, subjects may also receive valproic acid or phenobarbitone following the protocol. Follow-up was done in the second week and every month thereafter. At the end of the study period, seizure type was re-assessed and a repeat neurological and developmental examination and EEG was obtained to evaluate the role of clinical and EEG evolution in predicting intractability.

Results

Out of 71 subjects, 21 (29.6%) had intractable epilepsy at the end of the study period. Age of onset (p = 0.216) and neurological status (p = 0.052) were not associated with intractable epilepsy. On logistic regression analysis, evolution of seizure type (p < 0.001; RR 56.45; 95%CI 6.56 to 485.85) and evolution of background EEG rhythm (p < 0.001; RR 56.51; 95%CI 2.77 to 1152.16) were significantly associated with intractable epilepsy.

Conclusions

Changes in seizure type and baseline EEG rhythm may predict intractability in children one month to three years of age with focal epilepsy.

中文翻译：

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预测 3 岁以下儿童局灶性癫痫难治性的危险因素：一项队列研究

背景

与全身性癫痫相比，局灶性癫痫具有更高的难治性风险。了解难治性的危险因素将有助于指导儿童局灶性癫痫的治疗。除了初始诊断时存在的风险因素外，临床和脑电图特征的演变也可能在预测难治性方面发挥作用。

方法

对 1 个月至 3 岁的新诊断局灶性癫痫儿童进行了一项前瞻性队列研究。在评估临床表现、神经系统和发育状态、脑电图和脑部 MRI 后，根据标准方案给予卡马西平初始治疗。根据对治疗的反应，受试者还可以按照方案接受丙戊酸或苯巴比妥。在第二周和此后的每个月进行随访。在研究期结束时，重新评估癫痫发作类型，并重复进行神经和发育检查，并获得 EEG 以评估临床和 EEG 演变在预测顽固性方面的作用。

结果

在 71 名受试者中，21 名 (29.6%) 在研究期结束时患有顽固性癫痫。发病年龄 ( p  = 0.216) 和神经系统状态 ( p  = 0.052) 与顽固性癫痫无关。在逻辑回归分析中，癫痫发作类型的演变（p  < 0.001；RR 56.45；95%CI 6.56 至 485.85）和背景 EEG 节律的演变（p  < 0.001；RR 56.51；95%CI 2.77 至 1152.16）与难治性显着相关癫痫。

结论

癫痫发作类型和基线 EEG 节律的变化可以预测 1 个月至 3 岁局灶性癫痫儿童的顽固性。