Open AccessClinical profile and treatment outcome of epilepsy syndromes in children: A hospital‐based study in Eastern Nepal
Author(s) -
Poudel Prakash,
Kafle Shyam Prasad,
Pokharel Rita
Publication year - 2021
Publication title -
epilepsia open
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.247
H-Index - 16
ISSN - 2470-9239
DOI - 10.1002/epi4.12470
Subject(s) - juvenile myoclonic epilepsy , epilepsy , pediatrics , medicine , epilepsy syndromes , cerebral palsy , lennox–gastaut syndrome , pharmacotherapy , neurology , west syndrome , epilepsy in children , psychiatry
Objective It is often difficult to diagnose epilepsy syndromes in resource‐limited settings. This study was aimed to investigate the prospect of ascertaining the diagnosis, clinical profile, and treatment outcomes of epilepsy syndromes (ESs) among children in a resource‐limited setting. Methods This was a descriptive study done from 01/07/2009 to 15/06/2017 among children (1‐17 years of age) with unprovoked seizures presenting to the pediatric neurology clinic of a university hospital in eastern Nepal. Diagnosis, classification, and treatment of seizures were based upon International League Against Epilepsy guidelines. Results Of 768 children with unprovoked seizures, 120 (15.6%) were diagnosed as ES. The age of onset of seizure was unique for each ES. Developmental delay and cerebral palsy were present in 47.5% and 28.3% children, respectively. Common ESs were West syndrome (WS)‐26.7%, generalized tonic‐clonic seizures alone (GTCSA)‐21.7%, self‐limited childhood epilepsy with centrotemporal spikes (SLCECTS)‐12.5%, childhood absence epilepsy (CAE)‐10.0%, Lennox‐Gastaut syndrome (LGS)‐10.0%, other developmental and epileptic encephalopathies (DEE)‐5.8%, self‐limited familial infantile epilepsy (SLFIE)‐4.2%, and juvenile myoclonic epilepsy (JME)‐3.3%. Among children with known outcomes (87/120), overall response to pharmacotherapy and to monotherapy was observed in 72.4% (63/87) and 57.5% (50/87) children, respectively. All children with GTCSA, SLFIE, genetic epilepsy with febrile seizure plus (GEFS+), CAE, SLCECTS, and JME responded to pharmacotherapy and they had normal computerized tomography scans of the brain. Seizures were largely pharmaco‐resistant in progressive myoclonus epilepsy (PME)‐100.0%, LGS‐73.0%, WS‐52.0%, and other DEEs‐40%. Significance A reasonable proportion (15.6%) of unprovoked seizures could be classified into specific ES despite limited diagnostic resources. WS was the most common ES. GTCSA, SLCECTS, CAE, and LGS were other common ESs. GTCSA, SLFIE, CAE, SLCECTS, GEFS+, and JME were largely pharmaco‐responsive. PME, WS, and LGS were relatively pharmaco‐resistant. Electro‐clinical diagnosis of certain ES avoids the necessity of neuroimaging.