Intractable epilepsy in children who develop epilepsy in the first decade of life--a prospective study.

Prospective studies on 347 children under treatment due to seizures which appeared in the first 10 years of life helped to evaluate and define the incidence of epilepsy resistant to treatment. With regard to each patient the following aspects were analysed: the kind of seizures, their etiology, accompanying neurological disorders and a type of epileptic syndrome, kind of treatment applied before admission to the clinical department as well as socioeconomic conditions of the families. Patients under study were divided into four age groups to evaluate the results. Epilepsy, which was completely resistant to treatment, was observed in 10% of the patients, partially resistant in 20%. Resistance is the outcome of the following factors: onset of epilepsy in early childhood, symptomatic etiology coexisting symptoms of CNS damage, occurrence of unfavourable epileptic syndromes such as Lennox-Gastaut, wrong selection and low dosage of drugs, inappropriate polytherapy and adverse social conditions. On the basis of the results obtained, the authors suggested point evaluation as a kind of screening in prediction of failures in treatment.

Children who develop epilepsy in the first year of life: a prospective study.

A long-term prospective study was carried out of 133 children diagnosed as having epilepsy in the first year of life, of whom two-thirds had West syndrome and one-third had other forms of epilepsy. They were followed for a minimum of three years (half for over seven years), during which time 15 children died. Of the 118 surviving, 54 had an IQ of > 70, but 53 were severely mentally impaired, of whom two-thirds had West syndrome. Only 56 per cent currently have no seizures, and no significant differences were found in this respect between children with West syndrome and those with other forms of epilepsy. Regression in mental development occurred significantly more frequently among children with active epilepsy. These results lead to the conclusion that the degree and type of central nervous system damage existing at the onset of epilepsy is decisive for the outcome of the child, but the cessation of epileptic seizures also improves the child's developmental possibilities.