Etiology, clinical course and outcome of infant epilepsy: Experience of a tertiary center in Thailand.

PURPOSE: Explore etiology, clinical course and outcome of infant epilepsy in Bhumibol Adulyadej Hospital. METHOD: Retrospective and prospective descriptive analysis of infants 1 month to 1 year diagnosed with epilepsy between January 1, 2012, and April 30, 2018. RESULTS: Total 57 infants. Average age of seizure onset was 4.7 months. Follow-up period averaged 34.2 months. Prenatal risk factors were found in 28.1 percent (16/57). Of these, 50 percent (8/16) had seizure in neonatal period. An additional 6 infants without any prenatal risk factor had seizure in the neonatal period, bringing the total newborn with seizure to 24.6 percent (14/57). Family history of seizure was positive in only 15.8 percent (9/57). Neuroimaging was done 68.4 percent (39/57) and electroencephalogram 50.9 percent (29/57). The etiology was mostly structural 38.6 percent (22/57), followed by unknown 35.1 percent (20/57), genetics 14 percent (8/57), infection 10.5 percent (6/57) and metabolic 1.8 percent (1/57). Status epilepticus was found 21.1 percent of the times (12/57). Antiepileptic drugs were discontinued 19.3 percent (11/57). Intractable seizure was found 29.8 percent (17/57) and developmental delay 56.1 percent (32/57). By multivariate logistic regression analysis, status epilepticus and developmental delay predicted intractable seizure, whereas, abnormal neurological examination and abnormal neuroimaging predicted developmental delay. Mortality rate was 3.5 percent. CONCLUSION: The study shows that early onset of epilepsy in children under a year is similar to that found in children less than 2-3 years as found in prior studies. High percentages of intractable seizure and developmental delay were found.

Clinical course and long-term outcome in children with alteration of consciousness underwent continuous EEG monitoring: A prospective observational study in Thailand.

The study aims to explore the clinical course and long-term outcome in children with altered consciousness who underwent cEEG monitoring. A prospective observational study was conducted in neonatal and pediatric intensive care units from 1 September 2014 through 31 March 2017. Standard 10-20 cEEG monitoring was applied. Twenty children were included in this study. Their ages ranged from 1 day to 142.7 months (median age 40.6 months). Continuous EEG was commenced from 5 h to 5 days after the onset of alteration of consciousness (median 40.2 h). The range of EEG monitoring duration was 6.7-256.3 h (mean 50.4 h). Four patients (20%) had preexisting neurological diseases, which were 2 epilepsy, adrenoleukodystrophy and unknown cause of brain atrophy. Eleven patients (55%) had principle neurological diagnosis and the others 9 (45%) had systemic illnesses. Sixteen patients (80%) had clinical seizures prior to the commencement of cEEG monitoring. Fifteen patients (75%) received antiepileptic drugs before cEEG monitoring. NCSE was diagnosed in 25%. Comparison of patients' characteristics and long-term outcome between the NCSE and non NCSE groups, there was statistical significance between the two groups only with respect to epileptiform discharges. The patients are being follow up for a period of 24 months after the end of cEEG monitoring. The outcome of patients divided into those with a favorable outcome and those with poor outcome according to modified Rankin scale. The patients with isoelectric EEG background had relatively poorer outcomes than those with normal or slow background activities. The overall mortality rate for the entire population was 15%.