Muhammad Akbar Malik, Muhammad Arif Tarar, Bushra Javaid Karim, Muhammad Saeed, Ahmad Osaid Qureshi, Naseer Ahmad, Sadia Ikram, Samreen Sodoghar, Saima Malik, Qurban Ali.
Prognostic significance of response of the initial antiepileptic drug in childhood generalized epilepsy.
Pak Paed J Jan ;33(3):168-73.

Background: The efficacy of monotherapy with conventional antiepileptic drugs (AED) is well recognized in childhood epilepsy to limit the side effects of therapy. However, it may also predict the long term prognosis in terms of seizure control, depending on patient¡¯s response to therapy. Study Design: Hospital based prospective clinical interventional. Place: The Epilepsy Centre of the Children¡¯s Hospital Lahore. Period: From August, 2005 to July, 2008. Objectives: To investigate the response of patients to initial conventional AEDs, its prognostic value in long term seizure control and subsequent remission of seizures in newly diagnosed idiopathic and cryptogenic epilepsy. Methods: The single centre study was conducted from August, 2005 to July, 2008. Total 652 epileptic children and adolescents were diagnosed and enrolled in the study. Seventy five patients were excluded (51 lost in follow up, 24 had intolerable side effects) from study. A cohort of 577 patients was treated and followed 3 monthly. Outcome was classified as initial response at 3 months (>50% reduction in seizure severity and frequency), terminal remission (seizure free for the last year of study) and intractability (significant seizures at end of two years despite adequate treatment). Results: In the study population, 420 (73%) had idiopathic and 157(27%) cryptogenic epilepsy. At the last follow up visit ¡Ý2 years after study entry, 67% of the newly diagnosed epileptic children (n=387) were in remission for > 1 year. Among these well controlled patients 305 (53%) were among the initial responders to the first conventional antiepileptic drugs (AEDs). Intractable epilepsy was significantly higher in patients who were initial non responders to first conventional AED, p<0.001. A significantly higher proportion (n=310, 74%) of the idiopathic epileptics were in remission as compared with cryptogenic epileptics (n=62, 39%), P<0.001, and odd ratio 4.32 (95% CI 2.93-6.36). Conclusion: Our study suggests that there is high risk of intractable childhood epilepsy if these patients failed to respond to the initial conventional AEDs. Adequate dosage and compliance with initial AED is important as non responders carry a poor prognosis regarding long term seizure control.

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