Abstracts

Rationale: The unpredictability of seizures causes distress to patients with epilepsy and their caretakers. Clinical seizure prediction has been studied in the adult population with mixed results. To date, there have been no studies exploring seizure predictions specifically in the pediatric population. If the period of time preceding a seizure can be reliably identified, either by patient or caretaker, the distress of seizure unpredictability would be lessened, opening a role for pre-emptive interventions, including pharmacologic and behavioral methods, thus leading to clinical implications in the pediatric population. We hypothesized that caretakers of pediatric patients with epilepsy will report pre-ictal symptoms and seizure precipitants in the child they care for. Methods: In this cross-sectional study, a questionnaire is distributed to caretakers of patients with epilepsy. The patients are 0-21; experienced at least one seizure within the past year; and are hospitalized in the epilepsy monitoring unit or being seen in the outpatient neurology clinic. We exclude patients with non-epileptic seizures or daily seizures. The prevalence of reported clinical seizure prediction among caretakers is determined as a percent of positive report from the total questionnaires administered. Reported clinical seizure prediction is considered as a dichotomous outcome. The associations between making a positive report of seizure prediction and specific variables will be tested for significance. Reported pre-ictal symptoms and seizure precipitants are collected in a descriptive manner. The Montefiore-Einstein IRB approved the study. Results: The study is ongoing with a planned recruitment of 200 subjects. Preliminary analysis was conducted on the first 70 questionnaires, which have been returned since February 2014, 46 of which met criteria. The mean age was 9.9 years with a M:F ratio of 1:1.2. Of these 46 subjects, 9 (19.6%) caretakers indicated a positive report of seizure prediction. Age and gender distribution among these subjects did not differ from the overall group, nor did epilepsy syndrome. The range of times for seizure prediction was reported to be from 5 minutes up to 24 hours. Pre-ictal symptoms varied, but most commonly included being tired, hazy look, and sleepiness (figure 1). With regards to seizure precipitants, 85% of caretakers identified at least 1 precipitant. Fever or infection, not taking meds, stress or anxiety, and sleep deprivation were most commonly reported (figure 2). Conclusions: While preliminary, these data suggest that approximately 20% of caretakers report the ability to predict seizures in the children they care for. These numbers are similar to comparable studies in adults. Questionnaire studies are limited by recall bias, and these findings will be used to design more reliable electronic diary studies to further investigate caretaker's, as well as children's perspective on seizure prediction. We anticipate that this investigation may lead to novel treatments including pre-emptive therapies during times of high seizure risk.