Neurosciences Unit, Institute of Child Health and Shishu (Children's) Sasthya (Health) Foundation Hospital, Dhaka, Bangladesh.
Dev Med Child Neurol. 2012 Oct;54(10):918-24. doi: 10.1111/j.1469-8749.2012.04325.x. Epub 2012 Jun 11.
To identify predictors of seizure control in newly presenting children with epilepsy in countries with limited resources.
Three hundred and ninety children (273 males, 117 females) aged 2 months to 15 years with newly diagnosed epilepsy were enrolled prospectively at first visit to the multidisciplinary clinic at the children's hospital in Dhaka, Bangladesh. Data about seizures, motor disability, psychomotor development, and electroencephalography were obtained. Regular monitoring of antiepileptic drug treatment was continued at least for one year. Associations between seizure control and potential predictors were determined by multivariate analysis.
Three hundred and ninety children were enrolled in 6 months, of whom over 60% were from low-income families, 60% had onset at under 1 year, 74% had more than one seizure per week, 69% a single-seizure type, and 38% a history of delayed onset of breathing at birth. Cognitive deficits (IQ<70; 58%) and/or motor (significant limitation of daily living activities; 47%) deficits were common. After 1 year of regular treatment, seizure control was good (seizure freedom) in 53%, and poor (at least one seizure in the last 3mo of follow-up) in 47%. The predictors of poor seizure control were an IQ<70, associated motor disability, multiple seizure types, and a history of cognitive regression (1.9 times more likely to have poor seizure control).
Seizure control can be predicted using three clinical factors (motor disability, cognitive impairment, and multiple seizure types) at the first clinic visit. Such predictors assist the development of referral plans and management guidelines for childhood epilepsies in resource-poor countries.
在资源有限的国家中，确定新诊断为癫痫的儿童癫痫发作控制的预测因素。
前瞻性纳入 390 名（男 273 名，女 117 名）年龄在 2 个月至 15 岁的新诊断为癫痫的儿童，在孟加拉国达卡儿童医院的多学科诊所首次就诊时入组。收集有关癫痫发作、运动障碍、精神运动发育和脑电图的数据。在至少 1 年的时间内持续对抗癫痫药物治疗进行常规监测。通过多变量分析确定癫痫发作控制与潜在预测因素之间的关联。
在 6 个月内入组了 390 名儿童，其中超过 60%来自低收入家庭，60%的发病年龄在 1 岁以下，74%的儿童每周发作超过 1 次，69%的儿童发作类型为单次发作，38%的儿童有出生时呼吸延迟的病史。认知缺陷（智商<70；58%）和/或运动缺陷（日常生活活动显著受限；47%）很常见。在接受 1 年的常规治疗后，53%的儿童癫痫发作控制良好（无发作），47%的儿童癫痫发作控制不佳（在随访的最后 3 个月中至少有 1 次发作）。癫痫发作控制不佳的预测因素是智商<70、伴有运动障碍、多种发作类型和认知功能减退史（癫痫发作控制不佳的可能性增加 1.9 倍）。
在首次就诊时，可以使用三个临床因素（运动障碍、认知障碍和多种发作类型）来预测癫痫发作控制情况。这些预测因素有助于制定资源匮乏国家儿童癫痫的转诊计划和管理指南。
