Adult Seizures and Social Outcomes of Children with Partial Complex Seizures

Abstract & Commentary

By Nitin K. Sethi, MD, Assistant Professor of Neurology, Weill Cornell Medical College. Dr. Sethi reports no financial relationships relevant to this field of study.

Synopsis: Early and aggressive treatment of seizures, educational and social habilitation, as well as treatment of psychiatric comorbidities is advisable in intellectually normal children with focal epilepsy (partial complex seizures with or without secondary generalization).

Source: Camfield CS, Camfield PR. The adult seizure and social outcomes of children with partial complex seizures. Brain 2013;136(Pt 2):593-600.

Focal epilepsy (partial complex seizures or focal with secondary generalized seizures) is common in children. Intellectually normal children with focal epilepsy usually evade characterization into a specific epilepsy syndrome apart from those with benign Rolandic and benign occipital epilepsies. Long-term follow-up of these children with partial complex seizures but normal intelligence reveals that many fail to achieve adequate seizure control and remission with anticonvulsant therapy as compared to those children with only secondary generalized seizures. Long-term social outcome is also poor with a high prevalence of learning disorders, restricted social relationships (more likely to be single, unmarried, or living alone), poor socioeconomic status, lower educational status attained, and psychiatric comorbidities.

The authors investigated seizure and social outcomes in intellectually normal children with focal epilepsy when they grow up as adults. Cases were identified from the population-based Nova Scotia Childhood epilepsy cohort (1977 through 1985) and two groups were defined: those with solely secondary generalized seizures (SecGen seizures) and those with partial seizures with or without secondary generalized seizures (PCS) based on centralized EEG recordings with the diagnosis confirmed by chart review and personal interview. The patients and their parents, when possible, were interviewed by the authors by telephone between 2009 and 2012. Patients with PCS were likely to have more severe epilepsy, be on polypharmacy (> 2 antiepileptic drugs), and experience less frequent remissions as compared to the SecGen seizure group. Emotional and behavioral outcomes were unfavorable in both the groups with a higher prevalence of restricted social relationships, behavioral problems, and psychiatric diagnoses (other than attention deficit/hyperactivity disorder) in PCS as compared to the SecGen group. The authors recommend early and aggressive treatment of focal seizures, and educational and social rehabilitation in these intellectually normal children to improve their quality of life.

Commentary

Previous studies have yielded conflicting results in children with focal epilepsy, with some showing a good outcome (social and economic independence) while others showed continued seizures, especially in patients with structural lesions on MRI and unsatisfactory social, behavioral, and psychiatric outcomes.1,2 Future studies combining video-EEG characterization of epilepsy type (frontal vs temporal lobe) and seizure control, presence or absence of MRI lesion, and detailed neuropsychological testing shall yield more useful information. Studies investigating whether intensive and aggressive treatment of seizures, social, educational, and behavioral habilitation of these children at a young age improves outcome are also direly needed.

References

1. Sillanpää M, et al. Long-term prognosis of seizures with onset in childhood. N Engl J Med 1998;338:1715-1722.

2. Wakamoto H, et al. Long-term medical, educational, and social prognoses of childhood-onset epilepsy: A population-based study in a rural district of Japan. Brain Dev 2000;22:246-255.