title: Long-term outcome of epilepsy with onset in the first three years of life: Findings from a large cohort of patients.
abstract: BACKGROUND
  To describe the clinical features of patients with seizure onset within the first three years of life, and to evaluate risk factors for long-term prognosis.
  
  
  METHODS
  We selected 266 patients among 3096 individuals consecutively observed at a single Epilepsy Center between 1992 and 2012, and retrospectively analyzed their clinical, EEG, neuro-radiological and genetic characteristics.
  
  
  RESULTS
  Mean ages at epilepsy onset and at follow-up were 14.9 months and 29.3 years, respectively. Mean follow-up period 8.2 years. We identified a recognizable etiology in 147 individuals (55.2%), while 76 (28.6%) were classified as unknown cause and 43 (16.2%) as genetic, according to the ILAE criteria. Thirty-four patients (27.9%) had a confirmed genetic diagnosis and 12 (9.8%) had a metabolic diagnosis. Febrile seizures (p = 0.008), positive family history (p = 0.049), drug resistance (p = 0.048), moderate (p = 0.04) and severe intellectual disability (p = 0.005) were significantly more frequent in patients with seizure onset 0-12 months than in those with onset 13-36 months. Multiple regression analysis demonstrated a link between early age of epilepsy onset and intellectual disability (p = 0.008). No further variables were significantly associated with age at epilepsy onset (for etiology p = 0.095, for drug resistance p = 0.646, and for neuro-radiological findings p = 0.087).
  
  
  CONCLUSIONS
  Our study demonstrated worse outcome in symptomatic epilepsies in a large and representative sample. We also confirmed that the earlier age at seizure onset, the poorest the epilepsy outcome.
authors.affiliation: Epilepsy Center, San Paolo Hospital, Department of Health Sciences, University of Milan, Italy. Electronic address: aglaia.vignoli@unimi.it.
authors.forename: Aglaia
authors.initials: A
authors.lastname: Vignoli
authors.affiliation: Epilepsy Center, San Paolo Hospital, Department of Health Sciences, University of Milan, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Peron
authors.affiliation: Epilepsy Center, San Paolo Hospital, Milan, Italy.
authors.forename: Katherine
authors.initials: K
authors.lastname: Turner
authors.affiliation: Epilepsy Center, San Paolo Hospital, Milan, Italy.
authors.forename: Giulia Federica
authors.initials: GF
authors.lastname: Scornavacca
authors.affiliation: Epilepsy Center, San Paolo Hospital, Milan, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: La Briola
authors.affiliation: Epilepsy Center, San Paolo Hospital, Milan, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Chiesa
authors.affiliation: Epilepsy Center, San Paolo Hospital, Milan, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Zambrelli
authors.affiliation: Epilepsy Center, San Paolo Hospital, Department of Health Sciences, University of Milan, Italy.
authors.forename: Maria Paola
authors.initials: MP
authors.lastname: Canevini
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D000069279:Drug Resistant Epilepsy / Q000453:epidemiology* / Q000503:physiopathology; D004569:Electroencephalography; D004827:Epilepsy / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008607:Intellectual Disability / Q000453:epidemiology*; D007558:Italy / Q000453:epidemiology; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D003294:Seizures, Febrile / Q000453:epidemiology* / Q000503:physiopathology; D012720:Severity of Illness Index; D014888:Wechsler Scales; D055815:Young Adult
chemical_list: D000927:Anticonvulsants
keywords: Early onset epilepsy; Etiology; Intellectual disability; Long-term outcome; Seizures