title: Long-term course of Dravet syndrome: a study from an epilepsy center in Japan.
abstract: OBJECTIVE
  This study attempted to clarify the long-term course of Dravet syndrome (DS).
  
  
  METHODS
  Sixty-four patients diagnosed with DS (44 with typical DS, and 20 with atypical DS) were studied. The long-term outcomes of clinical seizures, electroencephalographic findings, neuropsychological findings, and social situation were analyzed. The follow-up period ranged from 11 to 34 years 5 months (median 24 years).
  
  
  RESULTS
  At the last visit, the ages ranged from 19 years to 45 years (median 30 years). Fifty-nine patients continued to have generalized tonic-clonic seizures (GTCS). Status epilepticus and unilateral seizures were not observed and myoclonic seizures, atypical absence seizures, and photosensitive seizures were resolved in most patients. The frequency of complex partial seizures was equally low, with five patients at presentation and six patients at the last visit, respectively. Five patients achieved seizure remission (seizure-free for 1 year or longer). Only 1 of 44 patients with typical DS had seizure remission, whereas 4 of 20 patients with atypical DS remitted, with a statistically significant difference between the two phenotypes (p = 0.03). Intellectual disability was found in all patients; especially, severe intellectual disability was prevalent. Patients with atypical DS tended to have milder intellectual disability compared to those with typical DS (p = 0.0283). Occipital alpha rhythm in the basic activity was associated with milder intellectual disability (p = 0.0085). The freedom from seizures correlated with appearance of occipital alpha rhythms (p = 0.0008) and disappearance of epileptic discharges (p = 0.0004). Two patients with GTCS died. Mutations of the neuronal voltage-gated sodium channel alpha subunit type 1 gene were detected at a high frequency (33 of 36 patients examined). Seizure remission was found only in the missense mutation group.
  
  
  CONCLUSIONS
  The long-term seizure and intellectual outcomes are extremely poor in patients with typical DS compared to those with atypical DS. Epilepsy phenotype may influence long-term course of DS.
authors: National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan.
authors: Rumiko
authors: R
authors: Takayama
authors: Tateki
authors: T
authors: Fujiwara
authors: Hideo
authors: H
authors: Shigematsu
authors: Katsumi
authors: K
authors: Imai
authors: Yukitoshi
authors: Y
authors: Takahashi
authors: Kazuhiro
authors: K
authors: Yamakawa
authors: Yushi
authors: Y
authors: Inoue
mesh_terms: D000328:Adult; D004569:Electroencephalography / Q000639:trends; D004831:Epilepsies, Myoclonic / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006761:Hospitals / Q000639:trends*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Intractable childhood epilepsy with generalized tonic-clonic seizure; Long-term course; Neuronal voltage-gated sodium channel alpha subunit type 1 gene; Severe myoclonic epilepsy in infancy