Long term course of childhood epilepsy following relapse after antiepileptic drug withdrawal.

OBJECTIVE: To explore the course of epilepsy following relapse after antiepileptic drug (AED) withdrawal. METHODS: Forty two patients were identified with onset of epilepsy in childhood in whom AEDs had been withdrawn after at least 2 years of seizure freedom, and in whom a relapse had occurred. Two patients were lost to follow up. RESULTS: Median follow up after AED withdrawal was 5.9 years (range 1.6-13.2 years). Relapse occurred in more than half of the patients within 6 months of AED withdrawal. At the end of follow up, 12 patients (30%) were seizure free for at least 1 year (mean 10.4 years) without medication; 16 (40%) were seizure free for at least 1 year (mean 5.3 years) with ongoing medication; and 12 patients (30%) were seizure free for less than 1 year with medication. No status epilepticus occurred in any patient after withdrawal. Age at onset, if over the age of 5, combined with normal intelligence were predictive of an excellent outcome; presence of a neurological disorder, and hence symptomatic aetiology, was predictive of poor outcome after a relapse. CONCLUSIONS: Fears that premature withdrawal of AEDs might result in uncontrollable seizures were unsubstantiated in this study. The current practice of withdrawing AEDs in children who have been seizure free for 2 years can be beneficial to most of these patients.

The course of benign partial epilepsy of childhood with centrotemporal spikes: a meta-analysis.

We performed a meta-analysis of studies on benign epilepsy of childhood with centrotemporal spikes (BECT) to ascertain whether clinical characteristics and outcome can be stated unequivocally. Using the Index Medicus and Medline CD+, we identified 525 publications. After applying the criteria of the International League against Epilepsy (ILAE) for BECT, 32 publications on 2,561 patients remained. After correction for inclusion bias and multiple publications on the same patient groups, 13 cohorts, comprising a total of 794 patients, were included. The aggregate proportional remission was 0.977; hence, no factors influencing outcome could be identified. Age at onset ranged from 3 months to 14 years, age at last seizure ranged from 3 to 18 years. A Kurtzke survival analysis of proportions of children in remission by age was performed; at an older age, the proportion of patients in remission was 0.9997. Publications had highly heterogeneous methodologies and population characteristics; we conclude that current knowledge on BECT has been determined mainly by retrospective studies of biased cohorts, and that the uniformity per se of BECT as an epileptic syndrome may be, at least in part, a result of selection bias. We conclude that early prediction of seizure outcome in a new patient with BECT can not be given with certainty. Prospective, population-based studies are needed to delineate the clinical and EEG characteristics of this syndrome.

The outcome of absence epilepsy: a meta-analysis.

We performed a meta-analysis of studies on absence epilepsy (AE) to ascertain whether the outcome of this well-defined type of epilepsy can be stated unequivocally. Using the Index Medicus and Medline CD+, we identified 1,619 publications. After applying the criteria of the International League against Epilepsy (ILAE) for AE, 26 publications on 23 study cohorts with a total of 2,303 patients were included. Remission rates ranged from 0.21 to 0.89; they differed substantially due to heterogeneity between the studies in inclusion criteria, methods, follow-up length, and outcome definitions. One half of the patients developed generalized tonic-clonic seizures (TCS) in the course of the disease. The proportion seizure free was 0.78 for patients with absence seizures (AS) only, and 0.35 for those who developed TCS. The outcome of AE may be worse than previously stated due to the considerable proportion of patients developing TCS in the course of their disease. Early prediction of outcome in patients who present with AS cannot be provided with certainty.

Lyme borreliosis presenting as acrodermatitis chronica atrophicans.

A patient is described who developed acrodermatitis chronica atrophicans, arthralgias and polyneuropathy as manifestations of Lyme borreliosis. The clinical diagnosis was confirmed by histological and serological examinations. Despite a long delay before the diagnosis was established, the patient responded very well to treatment with doxycycline.

Determining the prognosis of childhood epilepsies by establishing immune abnormalities.

When seizures develop in a child, an accurate prediction on outcome of the disorder can hardly be given. Literature indicating an association between seizure disorders and Immunoglobulin (Ig) abnormalities, HLA typing and the occurrence of anti-brain antibodies is shortly reviewed. It is argued that by determining such anti-brain antibodies, early ascertainment of prognosis in seizure disorders may be possible.

Discontinuation of antiepileptic therapy: a prospective study in children.

Anticonvulsant medication was stopped in a prospective study in 116 children with epilepsy who had had no seizures for a period of 2 years. A remission rate of 80.5% was found 5 years after withdrawal. The population studied was unselected, and based on children directly referred by general practitioners to the outpatient department. Among the many variables examined, such as type of epilepsy or seizure, presence of concomitant neurological or intellectual deficit, and epileptiform activity on the EEG, only the age of onset of seizures was significantly and positively correlated with the probability of recurrence after discontinuation of medication. In contrast to other recent studies, it was concluded that there are no reliable predictive factors for withholding from any individual "epileptic" child the benefit of attempts to stop medication after 2 years of seizure freedom.

Spelling errors made by children with mild epilepsy: writing-to-dictation.

Errors and corrections made by 64 mildly epileptic children of at least average intelligence who were attending ordinary elementary schools when writing in response to dictation (writing-to-dictation) were assigned to one of 28 descriptive error categories. Numbers and types of errors were compared with those obtained in 630 form-matched, healthy control subjects (Wilcoxon's two-sample test, less than or equal to 0.01). Epileptic children made significantly more errors than control subjects. Separate error categories had no diagnostic power. The groups could not be distinguished on the basis of skill-related errors. However, performance errors (erroneous deviations from the intended product), were found to be made more frequently by epileptic children. Epileptic children made more corrections and also left more errors uncorrected than control children. No relationship could be established with illness variables. Deficient problem-solving strategies, probably resulting from emotional concomitants of epilepsy, may explain the results.