title: Response to sequential treatment schedules in childhood epilepsy: risk for development of refractory epilepsy.
abstract: OBJECTIVE
  To investigate response to sequential treatment schedules and risk of development of refractory epilepsy in childhood.
  
  
  METHODS
  All children younger than 14 years with two or more unprovoked seizures seen at our hospital between 1994 and 2004 were included and prospectively followed. "Seizure control" was defined as a 2-year seizure-free interval without further recurrences except those related to attempts of medication withdrawal and "refractory epilepsy" as failure of >2 drugs plus >1 seizure/month for > or =18 months.
  
  
  RESULTS
  343 Patients were included, 191 males and 152 females. Mean age at diagnosis was 4y 10 mo (SD 3 year 10 month). Mean follow-up period was 76.2 mo (SD 35.2). The probability of achieving "seizure control" was 70% and 86% at 5 and 10 years. 59% of patients were "controlled" with the first drug used. Among patients failing the first, second and third therapeutic regimen due to lack of efficacy, 39%, 23% and 12% respectively were finally "controlled" with subsequent treatment schedules Risk of development of refractory epilepsy was 8% and 12% at 6 and 10 years.
  
  
  CONCLUSIONS
  After failing a first drug, a significant proportion of children can still be controlled with subsequent therapeutic schedules. Only a small proportion develops refractory epilepsy.
authors: Pediatric Neurology Unit, Department of Pediatrics, Torrecárdenas Hospital, Almería, Spain. jramoslizana@telefonica.net
authors: J
authors: J
authors: Ramos-Lizana
authors: P
authors: P
authors: Aguilera-López
authors: J
authors: J
authors: Aguirre-Rodríguez
authors: E
authors: E
authors: Cassinello-García
mesh_terms: D000293:Adolescent; D000927:Anticonvulsants / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004827:Epilepsy / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011379:Prognosis; D012074:Remission Induction; D012307:Risk Factors
chemical_list: D000927:Anticonvulsants