Amianto Federico, Davico Chiara, Bertino Federica, Bartolini Luca, Vittorini Roberta, Vacchetti Martina, Vitiello Benedetto
Neurosciences Department, Psychiatry Section, Service for Eating Disorders, University of Torino, Via Cherasco 11, 10126 Turin, Italy.
Department of Pediatrics, Regina Margherita Pediatric Hospital, 10126 Turin, Italy.
Children (Basel). 2022 Sep 23;9(10):1452. doi: 10.3390/children9101452.
Background: Idiopathic generalized epilepsies (IGEs) represent 15−20% of all cases of epilepsy in children. This study explores predictors of long-term outcome in a sample of children with childhood absence epilepsy (CAE). Methods: The medical records of patients with CAE treated at a university paediatric hospital between 1995 and 2022 were systematically reviewed. Demographics and relevant clinical data, including electroencephalogram, brain imaging, and treatment outcome were extracted. Outcomes of interest included success in seizure control and seizure freedom after anti-seizure medication (ASM) discontinuation. An analysis of covariance using the diagnostic group as a confounder was performed on putative predictors. Results: We included 106 children (age 16.5 ± 6.63 years) with CAE with a mean follow-up of 5 years. Seizure control was achieved in 98.1% (in 56.6% with one ASM). Headache and generalized tonic-clonic seizures (GTCS) were more frequent in children requiring more than one ASM (p < 0.001 and p < 0.002, respectively). Of 65 who discontinued ASM, 54 (83%) remained seizure-free, while 11 (17%) relapsed (mean relapse time 9 months, range 0−18 months). Relapse was associated with GTCS (p < 0.001) and number of ASM (p < 0.002). Conclusions: A history of headache or of GTCS, along with the cumulative number of ASMs utilized, predicted seizure recurrence upon ASM discontinuation. Withdrawing ASM in patients with these characteristics requires special attention.
特发性全身性癫痫（IGEs）占儿童癫痫病例总数的15%-20%。本研究探讨儿童失神癫痫（CAE）患儿长期预后的预测因素。方法：系统回顾了1995年至2022年在一家大学儿科医院接受治疗的CAE患者的病历。提取了人口统计学和相关临床数据，包括脑电图、脑部影像学和治疗结果。感兴趣的结果包括抗癫痫药物（ASM）停药后癫痫控制成功和无癫痫发作。对假定的预测因素进行以诊断组为混杂因素的协方差分析。结果：我们纳入了106例CAE患儿（年龄16.5±6.63岁），平均随访5年。98.1%的患儿实现了癫痫控制（56.6%使用一种ASM）。需要使用不止一种ASM的患儿头痛和全身强直阵挛性发作（GTCS）更频繁（分别为p<0.001和p<0.002）。在65例停用ASM的患儿中，54例（83%）仍无癫痫发作，而11例（17%）复发（平均复发时间9个月，范围0-18个月）。复发与GTCS（p<0.001）和ASM数量（p<0.002）相关。结论：头痛或GTCS病史以及使用ASM的累计数量可预测ASM停药后癫痫复发。对于具有这些特征的患者停用ASM需要特别关注。
