Predictors of medically intractable childhood epilepsy: clinical, electroencephalographic and neuroimaging factors

Predicting which children are destined to develop medically intractable seizures would be very helpful in developing treatment strategies that would be more aggressive than in children with easily controlled epilepsy. Little is known about the natural history, particularly the time course of development, of refractory epilepsy. To identify clinical, electroencephalographic [EEC] and neuroradiological factors associated with both seizure control and medical intractability in children with epilepsy and to be acquainted with predictors of uncontrolled seizures. A case-control study to identify predictors of medically intractable epilepsy in children. Cases were children who had an average of one seizure or more a month over a 2-year period and who, during that time, had failed trials of at least three different anti-epileptic drugs [AEDs]. Controls were children who had epilepsy, who had been seizure-free for >/= 2 years, and who had never, before becoming seizure-free, met the definition for intractable epilepsy. Features of clinical findings, EEG and Magnetic Resonance Imaging [MR1] were compared in 20 children with well controlled seizures and 40 with intractable epilepsy using contingency 2x2 tables for inference of associations, odds ratios, predictive values, sensitivity and specificity. Logistic regression -was performed for multivariate analysis. Strong associates of clinical factors with intractability included: age at onset; duration of epilepsy; multiple types of seizures; complex partial, simple partial, tonic, atonic and myoclonic seizures; initial seizure frequency; history of status epilepticus; history of febrile seizures; duration of fit at onset; lapse of time before treatment; receiving more than one A ED; a symptomatic etiology of the seizures, and abnormal magnetic resonance imaging [MRl] of the brain. Strong associates were noted between intractability and several EEG factors: abnormal EEG background including diffuse slowing, asymmetry and high frequency spikes. These factors were predictors of refractory epilepsy. With multiple logistic regression, independent predictors of intractability included: early risk factors, complex partial seizures and multi-focal or focal epileptic discharges with secondary generalization. There are a number of clinical, EEG and neuroradiological features that can be identified early in the course of childhood epilepsy that are predictive of outcome. These findings will need to be verified in a prospective study

Neurological prognosis of perinatal asphyxia: a clinical and electroencephalographic study

Perinatal asphyxia complicated by hypoxic ischemic brain injury still remains the source of serious and definitive neurological lesions. To establish a relation between clinical signs, EEC and outcome of perinatal asphyxia. A cohort of 64 neonates from the Neonatal Intensive Care Unit [NICU] Faculty of Medicine, Cairo University was enrolled in a prospective study. All the newborns had at least one criteria of perinatal asphyxia. Full clinical assessment and staging was done immediately after birth and one month later. An early electroencephalogram [EEG] was carried out on seventh day of life. Multivariate analysis based on the intake variables identified hypotonia, spasticity, weak or absent crying and EEG epileptogenic activity as independent predictors of poor outcome. All patients with mild encephalopathy had normal EEG background activity. Severe stages of asphyxia were significantly associated with low amplitude background, burst suppression pattern and other forms of background abnormalities as well as non-reactivity. Epileptogenic activity in EEG of these neonates increased the likelihood of uncontrolled seizures. Our study confirms the interest of the association of clinical settings and EEG tracings in the diagnosis and the prognostic of the hypoxic-ischemic encephalopathy in neonates