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Epilepsy in Childhood
An Audit of Clinical Practice
Hans A. Carpay, MD;
Willem F. M. Arts, MD, PhD;
Ada T. Geerts, MSc;
Hans Stroink, MD;
Oebele F. Brouwer, MD, PhD;
A. C. Boudewyn Peters, MD, PhD;
Cees A. van Donselaar, MD, PhD
Arch Neurol. 1998;55:668-673.
Background It is not known how many children with epilepsy may not need treatment with antiepileptic drugs (AEDs), how many respond unsatisfactorily to subsequent treatment regimens, and how many achieve "acceptable control" despite lack of remission.
Methods In a prospective multicenter hospital-based study, 494 children with a broad range of seizure types and types of epilepsy were followed up for at least 2 years. There was no standard treatment protocol. We describe the treatment strategies applied to these children by the neurologists in charge and outcome with respect to remission from seizures.
Results Treatment was initially withheld in 29% of the children, and after 2 years 17% still had not received any AEDs. There were no serious complications caused by withholding treatment. Of the children treated with AEDs, 60% were still using the first AED after 2 years; 80% received monotherapy and 20%, polytherapy. Children with severe symptomatic epilepsies, such as the West or Lennox-Gastaut syndrome, received polytherapy early on in the course of treatment. When 3 regimens had failed, the chance of achieving a remission of more than 1 year with subsequent regimens was 10%. Nevertheless, 15 of 50 children receiving AEDs in whom the "longest remission ever" was less than 6 months did achieve acceptable seizure control according to the neurologist in charge of treatment. Hence, of 494 children, only 35 (7%) developed an intractable form of epilepsy, defined as failure to bring seizures under acceptable control.
Conclusions A substantial percentage of children with new-onset epilepsy did not need treatment with AEDs. Chances of achieving a good outcome declined with subsequent treatment regimens. Not all children with recurrent seizures were suffering from intractable epilepsy; some had achieved acceptable control of seizures.
From the Departments of Child Neurology, Westeinde Hospital and Juliana Children's Hospital, the Hague (Drs Carpay and Arts), University Hospital–Sophia Children's Hospital, Rotterdam (Drs Arts and Stroink), and University Hospital–Wilhelmina Children's Hospital, Utrecht (Dr Peters); the Department of Public Health, Erasmus University, Rotterdam (Ms Geerts); and the Departments of Neurology, Leiden University Medical Center (Dr Brouwer), and University Hospital, Rotterdam (Dr van Donselaar), the Netherlands.
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