Two-Year Remission and Subsequent Relapse in a Prospectively Followed Cohort of Children with Newly Diagnosed Epilepsy.
Abstract number :
3.074
Submission category :
Year :
2000
Submission ID :
3311
Source :
www.aesnet.org
Presentation date :
12/2/2000 12:00:00 AM
Published date :
Dec 1, 2000, 06:00 AM
Authors :
Anne Berg, Shlomo Shinnar, Susan Levy, Francine Testa, Susan Smith-Rapaport, Barbara Beckerman, Northern Illinois Univ, Dekalb,, IL; Albert Einstein Coll of Medicine, Bronx, NY; Yale Medical Sch, New Haven, CT.
RATIONALE: An accurate understanding of the early course of pediatric epilepsy is necessary for rational treatment and clinical management as well as for planning on the part of the children and parents. METHODS: In a prospective, community-based cohort study of children with epilepsy (N=613, 1 month to <16 years at onset, median follow-up=4.5 years), occurrence of a two-year remission and relapse after remission were recorded. Predictors of remission and relapse, as assessed at the time of initial diagnosis, were examined. Multivariable analyses were done with Cox regression. RESULTS: A minimum 2 year follow-up was obtained on 592, of whom 392 (66.2%) had a 2-year remission. The probability of remission at 2, 3, 4 and 5 years after diagnosis was 18% (95% CI=15, 21%), 50% (46,54%), 66% (62, 70%), and 75% (71, 79%). In a multivariable model, idiopathic etiology [Rate Ratio (RR)=1.40 (1.12, 1.74), p=0.003] was associated with a significant increased likelihood of remission. Log of initial seizure frequency, [RR = 0.94 per increment log unit (0.89, 0.98), p=0.009], symptomatic etiology [RR=0.58 (0.42, 0.79), p<0.001)] and any slowing on the EEG [RR=0.89 (0.80, 1.0), p=0.05] with a significant decrease in the probability of remission. Of those in a 2-year remission, 70 (17.9%) subsequently relapsed. The risk of relapse at 6 months, and 1, 2, and 3 years after remission was 10% (7%, 13%), 15% (11%, 19%), 20% (16%, 24%), and 22% (17%, 27%). Three factors were associated with a significant decreased risk of relapse: log initial seizure frequency [RR=0.85 per log unit (0.76, 0.94), p=0.003], benign Rolandic epilepsy [RR=0.16 (0.04, 0.64), p=0.01], age at onset <1y [RR=0.21 (0.05, 0.87)], onset 1-5y [RR=0.56 (0.34, 0.93), p=0.02]. Focal slowing on the initial EEG was associated with an increased risk [RR=2.11 (1.11, 4.02) p=0.02]. After adjustment for these factors, stopping AEDs had a RR=1.48 (0.90, 2.44), p=0.13. CONCLUSIONS: Although over half of children enter 2-year remission, many do not do so immediately, and many eventually relapse. Factors predicting remission differ from those predicting relapse after remission.[NINDS RO1 NS-31146]