title: Symptomatic and presumed symptomatic focal epilepsies in childhood: An observational, prospective multicentre study.
abstract: To describe the clinical, neuropsychological, and psychopathologic features of a cohort of children with a new diagnosis of symptomatic or presumed symptomatic focal epilepsy at time of recruitment and through the first month. The selected population will be followed for 2-5 years after enrollment to investigate the epilepsy course and identify early predictors of drug resistance.
  
  
  
  In this observational, multicenter, nationwide study, children (age 1 month-12.9 years) with a new diagnosis of symptomatic or presumed symptomatic focal epilepsy were consecutively enrolled in 15 Italian tertiary childhood epilepsy centers. Inclusion criteria were as follows: (1) diagnosis of symptomatic focal epilepsy due to acquired and developmental etiologies, and presumed symptomatic focal epilepsy; (2) age at diagnosis older than 1 month and <13 years; and (3) written informed consent. Children were subdivided into three groups: ≤3 years, >3 to 6 years, and >6 years. Clinical, electroencephalography (EEG), neuroimaging, and neuropsychological variables were identified for statistical analyses.
  
  
  
  Two hundred fifty-nine children were enrolled (116 female and 143 male). Median age: 4.4 years (range 1 month-12.9 years); 46.0% (n = 119) of children were younger than 3 years, 24% (61) from 3 to 6 years of age, and 30% (79) older than 6 years. Neurologic examination findings were normal in 71.8%. Brain magnetic resonance imaging (MRI) was abnormal in 59.9%. Children age ≤3 years experienced the highest seizure frequency in the first month after recruitment (p < 0.0001). Monotherapy in the first month was used in 67.2%. Cognitive tests at baseline revealed abnormal scores in 30%; behavioral problems were present in 21%. At multivariate analysis, higher chances to exhibit more than five seizures in the first month after epilepsy onset was confirmed for younger children and those with temporal lobe epilepsy.
  
  
  
  In this prospective cohort study, an extensive characterization of epilepsy onset in children with symptomatic or presumed symptomatic focal epilepsies is reported in relation to the age group and the localization of the epileptogenic zone.
authors.affiliation: Department of Woman and Child Health, University of Padua, Padua, Italy.
authors.forename: Marilena
authors.initials: M
authors.lastname: Vecchi
authors.affiliation: Pediatric Neurology Unit and Laboratories, Children's Hospital Meyer-University of Florence, Florence, Italy.
authors.forename: Carmen
authors.identifier: 0000-0001-5445-5842
authors.initials: C
authors.lastname: Barba
authors.affiliation: Department of Woman and Child Health, University of Padua, Padua, Italy.
authors.forename: Debora
authors.initials: D
authors.lastname: De Carlo
authors.affiliation: Pediatric Neurology Unit and Laboratories, Children's Hospital Meyer-University of Florence, Florence, Italy.
authors.forename: Micol
authors.initials: M
authors.lastname: Stivala
authors.affiliation: Pediatric Neurology Unit and Laboratories, Children's Hospital Meyer-University of Florence, Florence, Italy.
authors.forename: Renzo
authors.initials: R
authors.lastname: Guerrini
authors.affiliation: Child Neurology and Psychiatry, Catholic University, Rome, Italy.
authors.forename: Emilio
authors.initials: E
authors.lastname: Albamonte
authors.affiliation: Child Neurology and Psychiatry, Catholic University, Rome, Italy.
authors.forename: Domiziana
authors.initials: D
authors.lastname: Ranalli
authors.affiliation: Child Neurology and Psychiatry, Catholic University, Rome, Italy.
authors.forename: Domenica
authors.initials: D
authors.lastname: Battaglia
authors.affiliation: Department of Woman and Child Health, University of Padua, Padua, Italy.
authors.forename: Giada
authors.initials: G
authors.lastname: Lunardi
authors.affiliation: Department of Woman and Child Health, University of Padua, Padua, Italy.
authors.forename: Clementina
authors.initials: C
authors.lastname: Boniver
authors.affiliation: Child Neuropsychiatry Unit, University-Hospital of Parma, Parma, Italy.
authors.forename: Benedetta
authors.initials: B
authors.lastname: Piccolo
authors.affiliation: Child Neuropsychiatry Unit, University-Hospital of Parma, Parma, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Pisani
authors.affiliation: Child Neuropsychiatry Unit, University-Hospital of Parma, Parma, Italy.|Department of Life and Reproduction Sciences, University of Verona, Verona, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Cantalupo
authors.affiliation: Department of Child Neuropsychiatry, University of Sassari, Sassari, Italy.
authors.forename: Giuliana
authors.initials: G
authors.lastname: Nieddu
authors.affiliation: Department of Child Neuropsychiatry, University of Sassari, Sassari, Italy.
authors.forename: Susanna
authors.initials: S
authors.lastname: Casellato
authors.affiliation: Child Neuropsychiatric Unit, University of Ancona, Ancona, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Cappanera
authors.affiliation: Child Neuropsychiatric Unit, University of Ancona, Ancona, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Cesaroni
authors.affiliation: Child Neuropsychiatric Unit, University of Ancona, Ancona, Italy.
authors.forename: Nelia
authors.initials: N
authors.lastname: Zamponi
authors.affiliation: Neuroscience Department, Pediatric Neurology Unit, "Bambino Gesù" Children's Hospital, IRCCS, Rome, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Serino
authors.affiliation: Neuroscience Department, Pediatric Neurology Unit, "Bambino Gesù" Children's Hospital, IRCCS, Rome, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Fusco
authors.affiliation: Pediatric Neuropsychiatric Division, "Spedali Civili", Brescia, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Iodice
authors.affiliation: Pediatric Neuropsychiatric Division, "Spedali Civili", Brescia, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Palestra
authors.affiliation: Pediatric Neuropsychiatric Division, "Spedali Civili", Brescia, Italy.
authors.forename: Lucio
authors.initials: L
authors.lastname: Giordano
authors.affiliation: Department of Pediatric Neuroscience, Foundation I.R.C.C.S. Neurological Institute C. Besta, Milan, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Freri
authors.affiliation: Department of Pediatric Neuroscience, Foundation I.R.C.C.S. Neurological Institute C. Besta, Milan, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: De Giorgi
authors.affiliation: Department of Pediatric Neuroscience, Foundation I.R.C.C.S. Neurological Institute C. Besta, Milan, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Ragona
authors.affiliation: Department of Pediatric Neuroscience, Foundation I.R.C.C.S. Neurological Institute C. Besta, Milan, Italy.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Granata
authors.affiliation: Pediatric Neurology Unit, V. Buzzi Hospital, A.O. ICP, Milan, Italy.
authors.forename: Isabella
authors.initials: I
authors.lastname: Fiocchi
authors.affiliation: Pediatric Neurology Unit, V. Buzzi Hospital, A.O. ICP, Milan, Italy.
authors.forename: Stefania Maria
authors.initials: SM
authors.lastname: Bova
authors.affiliation: Pediatric Neurology Unit, V. Buzzi Hospital, A.O. ICP, Milan, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Mastrangelo
authors.affiliation: Department of Pediatrics, University of L'Aquila, L'Aquila, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Verrotti
authors.affiliation: Department of Pediatrics, University of Perugia, Perugia, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Matricardi
authors.affiliation: Department of Life and Reproduction Sciences, University of Verona, Verona, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Fontana
authors.affiliation: Department of Life and Reproduction Sciences, University of Verona, Verona, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Caputo
authors.affiliation: Department of Life and Reproduction Sciences, University of Verona, Verona, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Darra
authors.affiliation: Department of Life and Reproduction Sciences, University of Verona, Verona, Italy.
authors.forename: Bernardo
authors.initials: B
authors.lastname: Dalla Bernardina
authors.affiliation: Department of Child Neuropsychiatry, Epilepsy Center, C. Poma Hospital, Mantova, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Beccaria
authors.affiliation: Department of Child Neuropsychiatry, Epilepsy Center, C. Poma Hospital, Mantova, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Capovilla
authors.affiliation: Maternal and Child Health, G. Gaslini Institute, University of Genoa, Genoa, Italy.
authors.forename: Maria Pia
authors.initials: MP
authors.lastname: Baglietto
authors.affiliation: Maternal and Child Health, G. Gaslini Institute, University of Genoa, Genoa, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Gagliardi
authors.affiliation: Department of Health Science, Epilepsy Center, San Paolo Hospital, University of Milan, Milan, Italy.
authors.forename: Aglaia
authors.initials: A
authors.lastname: Vignoli
authors.affiliation: Department of Health Science, Epilepsy Center, San Paolo Hospital, University of Milan, Milan, Italy.
authors.forename: Maria Paola
authors.initials: MP
authors.lastname: Canevini
authors.affiliation: Department of Environmental Medicine and Public Health, University of Padua, Padua, Italy.
authors.forename: Egle
authors.initials: E
authors.lastname: Perissinotto
authors.affiliation: Claudio Munari Epilepsy Surgery Centre, Niguarda Hospital, Milan, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Francione
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D001921:Brain / Q000000981:diagnostic imaging*; D002648:Child; D002675:Child, Preschool; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology*; D015331:Cohort Studies; D004569:Electroencephalography; D004828:Epilepsies, Partial / Q000150:complications* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D009483:Neuropsychological Tests; D011446:Prospective Studies
keywords: Behavior impairment; Childhood epilepsy; Cognitive function; Focal symptomatic seizures; Intractable epilepsy