Abstracts

Rationale: Most focal seizures in children are partial complex (PCS) or focal with secondary generalization (SecGen) and typically not associated with a precise epilepsy syndrome. Remission rates are high in children with epilepsy and normal intelligence, but few studies have addressed the long-term outcome of these two seizure types.Methods: Cases from the population-based Nova Scotia Childhood Epilepsy cohort provided a convenience sample (~66% of eligible patients). Patients had seizure onset between1977-85 with follow-up in 2009-2011. For this study, all patients had normal intelligence and ?10 years follow-up from diagnosis. Two groups with focal seizures were identified: 1) PCS with or without SecGen as the only seizure types throughout the clinical course (PCS group) and 2) SecGen as the only seizure type (SecGen group). Patients were excluded if they had a defined, benign epilepsy syndrome such as Benign Rolandic or other well-defined genetic epilepsy syndromes such as ADNFLE. Results: For the PCS group n=88 and for the SecGen group n=57. Age of onset was 7 4.5 years in SecGen group and 7.6 4.5 in the PCS group (p=ns). Follow-up averaged 27.5 5 years (range 13-38) for both groups with average final age of 34.5 7.5 years. In the PCS group, 30% had only partial complex seizures, while 70% had partial complex + additional secondarily generalized seizures. Seizure outcome was considerably worse in the PCS group. In the last year of follow-up, 40% of the PCS group continued to have seizures versus 2% in the SecGen group (p=0.00001). At the end of follow-up, 44% of the PCS group were in remission (seizure-free without daily AEDs) versus 82% of the SecGen group (p=0.000005). Those with PCS were more likely to be intractable and/or have undergone seizure surgery (37.5% vs 5.2% p= 0.00001). During follow-up, 36% of patients in the PCS group had <5 years seizure-free compared with 3.5% of the SecGen group (p=0.00005). Psychiatric and cognitive outcomes were also less favourable in the PCS group. More in PCS group were seen by a mental health professional (64% vs 24%, p=0.00001) and 31% of the PCS group had a psychiatric diagnosis beyond ADHD versus 15% of SecGen (p=0.005). Uncomplicated ADHD treated with stimulant medications was similar in the two groups (16% vs. 7%, p=ns). All patients had normal intelligence but those in the PCS group were much more likely to have a defined learning disorder (44% vs. 25%, p=0.02), documented by psychological testing in 99%. Conclusions: The development of partial complex seizures in intellectually normal childhood is ominous compared with secondarily generalized seizures only. More than half of those with PCS have a profile of difficult to control or intractable seizures, learning difficulties and psychiatric problems. Those with SecGen only usually have remission with good psychiatric and cognitive outcomes. Early intensive, interventions for seizures and emotional state are clearly indicated for children with partial complex seizures.