title: Long-term outcomes of generalized tonic-clonic seizures in a childhood absence epilepsy trial.
abstract: OBJECTIVE
  To determine incidence and early predictors of generalized tonic-clonic seizures (GTCs) in children with childhood absence epilepsy (CAE).
  
  
  METHODS
  Occurrence of GTCs was determined in 446 children with CAE who participated in a randomized clinical trial comparing ethosuximide, lamotrigine, and valproate as initial therapy for CAE.
  
  
  RESULTS
  As of June 2014, the cohort had been followed for a median of 7.0 years since enrollment and 12% (53) have experienced at least one GTC. The median time to develop GTCs from initial therapy was 4.7 years. The median age at first GTC was 13.1 years. Fifteen (28%) were not on medications at the time of their first GTC. On univariate analysis, older age at enrollment was associated with a higher risk of GTCs (p=-0.0009), as was the duration of the shortest burst on the baseline EEG (p=0.037). Failure to respond to initial treatment (p<0.001) but not treatment assignment was associated with a higher rate of GTCs. Among patients initially assigned to ethosuximide, 94% (15/16) with GTCs experienced initial therapy failure (p<0.0001). A similar but more modest effect was noted in those initially treated with valproate (p=0.017) and not seen in those initially treated with lamotrigine.
  
  
  CONCLUSIONS
  The occurrence of GTCs in a well-characterized cohort of children with CAE appears lower than previously reported. GTCs tend to occur late in the course of the disorder. Children initially treated with ethosuximide who are responders have a particularly low risk of developing subsequent GTCs.
authors: From Montefiore Medical Center (S.S., D.M., S.L.M.), Albert Einstein College of Medicine, New York, NY; Children's National Health System (A.C., F.H.), Washington, DC; Cincinnati Children's Hospital Medical Center (P.C., T.A.G.); the University of Cincinnati College of Medicine (P.C., T.A.G.), OH; The Children's Hospital of Philadelphia (D.D.), Perelman School of Medicine at the University of Pennsylvania; National Institute of Neurological Disorders and Stroke (D.G.H.), Bethesda, MD; and Baylor College of Medicine (E.M.M.), Houston, TX. sshinnar@aol.com.
authors: Shlomo
authors: S
authors: Shinnar
authors: From Montefiore Medical Center (S.S., D.M., S.L.M.), Albert Einstein College of Medicine, New York, NY; Children's National Health System (A.C., F.H.), Washington, DC; Cincinnati Children's Hospital Medical Center (P.C., T.A.G.); the University of Cincinnati College of Medicine (P.C., T.A.G.), OH; The Children's Hospital of Philadelphia (D.D.), Perelman School of Medicine at the University of Pennsylvania; National Institute of Neurological Disorders and Stroke (D.G.H.), Bethesda, MD; and Baylor College of Medicine (E.M.M.), Houston, TX.
authors: Avital
authors: A
authors: Cnaan
authors: From Montefiore Medical Center (S.S., D.M., S.L.M.), Albert Einstein College of Medicine, New York, NY; Children's National Health System (A.C., F.H.), Washington, DC; Cincinnati Children's Hospital Medical Center (P.C., T.A.G.); the University of Cincinnati College of Medicine (P.C., T.A.G.), OH; The Children's Hospital of Philadelphia (D.D.), Perelman School of Medicine at the University of Pennsylvania; National Institute of Neurological Disorders and Stroke (D.G.H.), Bethesda, MD; and Baylor College of Medicine (E.M.M.), Houston, TX.
authors: Fengming
authors: F
authors: Hu
authors: From Montefiore Medical Center (S.S., D.M., S.L.M.), Albert Einstein College of Medicine, New York, NY; Children's National Health System (A.C., F.H.), Washington, DC; Cincinnati Children's Hospital Medical Center (P.C., T.A.G.); the University of Cincinnati College of Medicine (P.C., T.A.G.), OH; The Children's Hospital of Philadelphia (D.D.), Perelman School of Medicine at the University of Pennsylvania; National Institute of Neurological Disorders and Stroke (D.G.H.), Bethesda, MD; and Baylor College of Medicine (E.M.M.), Houston, TX.
authors: Peggy
authors: P
authors: Clark
authors: From Montefiore Medical Center (S.S., D.M., S.L.M.), Albert Einstein College of Medicine, New York, NY; Children's National Health System (A.C., F.H.), Washington, DC; Cincinnati Children's Hospital Medical Center (P.C., T.A.G.); the University of Cincinnati College of Medicine (P.C., T.A.G.), OH; The Children's Hospital of Philadelphia (D.D.), Perelman School of Medicine at the University of Pennsylvania; National Institute of Neurological Disorders and Stroke (D.G.H.), Bethesda, MD; and Baylor College of Medicine (E.M.M.), Houston, TX.
authors: Dennis
authors: D
authors: Dlugos
authors: From Montefiore Medical Center (S.S., D.M., S.L.M.), Albert Einstein College of Medicine, New York, NY; Children's National Health System (A.C., F.H.), Washington, DC; Cincinnati Children's Hospital Medical Center (P.C., T.A.G.); the University of Cincinnati College of Medicine (P.C., T.A.G.), OH; The Children's Hospital of Philadelphia (D.D.), Perelman School of Medicine at the University of Pennsylvania; National Institute of Neurological Disorders and Stroke (D.G.H.), Bethesda, MD; and Baylor College of Medicine (E.M.M.), Houston, TX.
authors: Deborah G
authors: DG
authors: Hirtz
authors: From Montefiore Medical Center (S.S., D.M., S.L.M.), Albert Einstein College of Medicine, New York, NY; Children's National Health System (A.C., F.H.), Washington, DC; Cincinnati Children's Hospital Medical Center (P.C., T.A.G.); the University of Cincinnati College of Medicine (P.C., T.A.G.), OH; The Children's Hospital of Philadelphia (D.D.), Perelman School of Medicine at the University of Pennsylvania; National Institute of Neurological Disorders and Stroke (D.G.H.), Bethesda, MD; and Baylor College of Medicine (E.M.M.), Houston, TX.
authors: David
authors: D
authors: Masur
authors: From Montefiore Medical Center (S.S., D.M., S.L.M.), Albert Einstein College of Medicine, New York, NY; Children's National Health System (A.C., F.H.), Washington, DC; Cincinnati Children's Hospital Medical Center (P.C., T.A.G.); the University of Cincinnati College of Medicine (P.C., T.A.G.), OH; The Children's Hospital of Philadelphia (D.D.), Perelman School of Medicine at the University of Pennsylvania; National Institute of Neurological Disorders and Stroke (D.G.H.), Bethesda, MD; and Baylor College of Medicine (E.M.M.), Houston, TX.
authors: Eli M
authors: EM
authors: Mizrahi
authors: From Montefiore Medical Center (S.S., D.M., S.L.M.), Albert Einstein College of Medicine, New York, NY; Children's National Health System (A.C., F.H.), Washington, DC; Cincinnati Children's Hospital Medical Center (P.C., T.A.G.); the University of Cincinnati College of Medicine (P.C., T.A.G.), OH; The Children's Hospital of Philadelphia (D.D.), Perelman School of Medicine at the University of Pennsylvania; National Institute of Neurological Disorders and Stroke (D.G.H.), Bethesda, MD; and Baylor College of Medicine (E.M.M.), Houston, TX.
authors: Solomon L
authors: SL
authors: Moshé
authors: From Montefiore Medical Center (S.S., D.M., S.L.M.), Albert Einstein College of Medicine, New York, NY; Children's National Health System (A.C., F.H.), Washington, DC; Cincinnati Children's Hospital Medical Center (P.C., T.A.G.); the University of Cincinnati College of Medicine (P.C., T.A.G.), OH; The Children's Hospital of Philadelphia (D.D.), Perelman School of Medicine at the University of Pennsylvania; National Institute of Neurological Disorders and Stroke (D.G.H.), Bethesda, MD; and Baylor College of Medicine (E.M.M.), Houston, TX.
authors: Tracy A
authors: TA
authors: Glauser
mesh_terms: D000367:Age Factors; D000927:Anticonvulsants / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D004832:Epilepsy, Absence / Q000188:drug therapy / Q000453:epidemiology*; D004830:Epilepsy, Tonic-Clonic / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D016032:Randomized Controlled Trials as Topic; D012306:Risk; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants