Classification and management of epilepsy and epileptic syndromes in a cohort of 202 school children- a 2 year follow up study- Sudan
Tóm tắt
In this paper, seizure types, and epilepsy syndromes are elucidated as per ILAE (2010) classification. A brief outline of the antiepileptic drug regimens used and the outcome of seizure control in a two -year period is presented. The applicability of the ILAE classification in resource limited countries has been revisited. This is a descriptive prospective study, in which 202 patients were enrolled. The Cohort group was seen and evaluated by a pediatric neurologist at the Pediatric neurology Outpatients Department (OPD). Epilepsy was classified using the International League Against Epilepsy (ILAE) classification (2005–2009) report. All patients had an Electroencephalogram (EEG) at the start of the study, and this was repeated as deemed appropriate. Brain imaging (MRI) was done to patients when indicated. Treatment decisions were made by pediatric neurologists. Outcomes were categorized into four groups: fully recovered, well controlled, partially controlled and uncontrolled. The mean age is 10.5 + 2.7 years. Male to female ratio was 1.7: 1. Thirty five (17.3%) patients had generalized onset seizures, 46(22.8%) had focal onset seizures, 104(51.5%) had a specific epilepsy syndrome, and 17(8.4%) patients were unclassified. 170 (84.2%) patients were on mono-therapy on their initial visit, 30(14.8%) were on two Antiepileptic Drugs (AEDs) while two (1.0%) patients were on poly-therapy. After 2 years; 155(76.7%) patients were on mono-therapy, 36(17.8%) on two AEDs while ten were (4.0%) on polytherapy. One eighty (88.2%) patients were controlled. Fifteen (7.4%) of them were off medication after being seizure free for 2 years. Twenty (9.8%) have partial control, while two (1.0%) patients were uncontrolled. Patients with focal epilepsy, those on polytherapy and those with abnormal imaging had poor prognosis. The ILAE classification can be used in resource limited countries. Childhood epilepsies have a good prognosis provided they are well classified and treated.
Tài liệu tham khảo
Shlomo Shinnar John M. Update on the Epidemiology and Prognosis of Pediatric Epilepsy. J Child Neurol. 2002. https://doi.org/10.1177/08830738020170010201.
The World Health Report, 2001. Mental health: new understanding, new hope. 1st ed. Geneva: WHO; 2002.
Mohammed IN, Elssed MA, Rahman AA. The profile of childhood epilepsy in Sudan. KMJ. 2010;2:444–7.
Mohamed IN, Elseed MA, Hamed AA, AbdelRahman ME, El-Sadig SM, Ilham M, et al. Prevalence of epilepsy in 74,949 school children in Khartoum state, Sudan. Paediatrics and International Child Health. 2017;37:188–92.
Bax M, Goldstein M, Rosenbaum P, Leviton A, Paneth N, Dan B, et al. Proposed definition and classification of cerebral palsy. Dev Med Child Neurol. 2005;47:571–6.
Anne T, Samuel B, Berkovic MJ, Buchhalter J, Cross H, et al. Revised terminology and concepts for organization of seizures and epilepsies: report of the ILAE commission on classification and terminology, 2005–2009. Epilepsies. 2010;5:676–85.
Bernd A. Neubauer, Stephanie Gro, Andreas Hahn. Epilepsy in Childhood and Adolescence Medicine 2008; 105:319–28.
Mohamed IN, Babeker H. Traditional and spiritual medicine among Sudanese patients with epilepsy. Sudanese Journal of Paediatrics. 2013;13:31–7.
Oka E, Ohtsuka Y, Yoshinaga H, Murakami N, Kobayashi K, Ogino T. Prevalence of Childhood Epilepsy and Distribution of Epileptic Syndromes: A Population-based Survey in Okayama, Japan. Epilepsia. 2006;47:626–30.
Sillanpää M, Jalava M, Shinnar S. Epilepsy syndromes in patients with childhood-onset seizures in Finland. Pediatr Neurol. 1999;21:533–7.
Burton KJ, Rogathe J, Whittaker R, Mankad K, Hunter E, Burton MJ, et al. Epilepsy in Tanzanian children: association with perinatal events and other risk factors. Epilepsia. 2012;53:752–60.
Dent W, Helbok R, Matuja WB, Scheunemann S, Schmutzhard E. Prevalence of active epilepsy in a rural area in South Tanzania: a door to-door survey. Epilepsia. 2005;46:1963–9.
Edwards T, Scott AG, Munyoki G, Odera VM, Chengo E, Bauni E, Kwasa T, et al. Active convulsive epilepsy in a rural district of Kenya : a study of prevalence and possible risk factors. Lancet Neurol. 2008;l7:50–6.
Mung’ala-Odera V, White S, Meehan R, Otieno GO, Njuguna P, Mturi N, et al. Prevalence, incidence and risk factors of epilepsy in older children in rural Kenya. Seizure. 2008;17:396–404.
Munyoki G, Edwards T, White S, Kwasa T, Chengo E, Kokwaro G, et al. Clinical and neurophysiologic features of active convulsive epilepsy in rural Kenya: a population-basedstudy. Epilepsia. 2010;51:2370–6.
Sidenvall R, Forsgren L, Heijbel J. Prevalence and characteristics of epilepsy in children in northern Sweden. Seizure. 1996;5:139–46.
Braathen G, Theorell K. A general hospital population of childhood epilepsy. Acta Paediatr Scand. 1995;84(11):43–6.
Cavazzuti GB. Epidemiology of different types of epilepsy in school age children of Modena, Italy. Epilepsia. 1980;21:57–62.
Eriksson KJ, KoiviMco MJ. Prevalence, classification, and severity of epilepsy and epileptic syndromes in children. Epilepsia. 1997;38:1275–82.
Stefienburg U, Hagberg G, Viggedal G, Kyllerman M. Active epilepsy in mentally retarded children: I. Prevalence and additional neuro-impairments. Acta Paediatr Scand. 1995;84(1):147–52.
Verrotti A, Mazzocchetti C. Beyond seizures — the importance of comorbidities in epilepsy. Pediatrics Nature Reviews. 2016;12:559–60.
Tidman L, Saravanan K, Gibbs J. Epilepsy in mainstream and special educational primary school settings. Seizure. 2003;12:47–51.
Camfield PR, Camfield CS, Gordon K, Dooley JM. If’ a first anti-epileptic drug fails to control a child's epilepsy, what are the chances of success with the next drug? J Pediatr. 1997;13(1):82.
Wirrell EC, Grossardt BR, Lily W-K, Nickels KC. Incidence and Classification of New-Onset Epilepsy and Epilepsy Syndromes in Children in Olmsted County, Minnesota from 1980–2004: A population-based study. Epilepsy Res. 2011;03:009.
Brorson LO, Wranne L. Long-term prognosis in childhood epilepsy: survival and seizure prognosis. Epilepsia. 1987;28(4):324–30.
Arts WF, Brouwer OF, Peters AC, Stroink H, Peeters EA, van Schmitz PI, et al. Course and prognosis of childhood epilepsy: 5-year follow-up of the Dutch study of epilepsy in childhood. Brain. 2004;127:1774–84.
Eddy CM, Rickards HE, Cavanna AE. The cognitive impact of antiepileptic drugs. Ther Adv Neurol Disord. 2011;4:385–407.
Jung JY, Cho JW, Joo EY, Kim SH, Choi KM, Chin J, et al. Cognitive effects of Topiramate revealed by standardized low-resolution brain electromagnetic tomography (sLORETA) of event-related potentials. Clin Neurophysiol. 2010;121:1494–501.