Childhood absence epilepsy: evolution and prognostic factors.
OBJECTIVE
To evaluate how diagnostic criteria influence remission rates for patients with childhood absence epilepsy (CAE) and to assess clinical and EEG parameters as predictors of outcome.


METHODS
One hundred nineteen patients were diagnosed with CAE, according to International League Against Epilepsy (ILAE) classification criteria. They were subsequently evaluated according to stricter diagnostic criteria. Sixty-two subjects fulfilled these criteria as group 2; 57 did not and constituted group 1. Diagnostic parameters that prevented patients of group 1 from entering group 2, and variables such as sex, familial history of generalized epilepsy, and personal history of febrile convulsions also were tested as prognostic factors for terminal remission.


RESULTS
Compared with those in group 1, patients of group 2 had significantly higher rates of seizure control (95% vs. 77%), higher rates of terminal remission (82% vs. 51%), fewer generalized tonic-clonic seizures (8% vs. 30%), and shorter mean periods of treatment (2.2 vs. 3.8 years). Significantly fewer patients were receiving polytherapy in group 2 than in group 1 (11% vs. 47%), and fewer patients had seizure relapses at antiepileptic drug discontinuation (0 vs. 22%).


CONCLUSIONS
Remission rates of patients with CAE are greatly influenced by the classification criteria used for selection. Stricter diagnostic criteria allow the definition of a homogeneous group of patients with excellent prognosis. Factors predicting unfavorable prognosis were generalized tonic-clonic seizures in the active stage of absences, myoclonic jerks, eyelid myoclonia or perioral myoclonia, and EEG features atypical for CAE.
Grosso
Salvatore
S
Department of Pediatrics, Pediatric Neurology Section, University of Siena, Siena, Italy.
Galimberti
Daniela
D
Vezzosi
Piero
P
Farnetani
Mariangela
M
Di Bartolo
Rosanna Maria
RM
Bazzotti
Simone
S
Morgese
Guido
G
Balestri
Paolo
P
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000927:Anticonvulsants / Q000627:therapeutic use; D002648:Child; D004569:Electroencephalography / Q000379:methods / Q000706:statistics & numerical data*; D004832:Epilepsy, Absence / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D018579:Patient Selection; D011237:Predictive Value of Tests; D011379:Prognosis; D055502:Secondary Prevention; D016896:Treatment Outcome
D000927:Anticonvulsants