Historical trend toward improved long-term outcome in childhood absence epilepsy

Epilepsy Res. 2019 May:152:7-10. doi: 10.1016/j.eplepsyres.2019.02.013. Epub 2019 Feb 25.

Abstract

We retrospectively analyzed published studies to investigate historical trends in outcome of childhood absence epilepsy (CAE). We included patients based on onset of absence seizures in childhood, 3 Hz bilateral spike-wave discharges on EEG, and availability of seizure-free outcome data. The primary endpoint was seizure-freedom off medications by study publication year. We also analyzed relationships between seizure-freedom and 1. treatment medication, and 2. CAE diagnostic criteria. We included 29 studies published 1945-2013, encompassing 2416 patients. Seizure-freedom off medications was higher for studies after 1985 versus before 1975 (82% versus 35%; p < 0.001). Ethosuximide and valproate were used more commonly after 1985, and patients previously treated with ethosuximide or valproate had higher seizure-freedom off medications than those treated only with other medications (64% versus 32%; χ2>10; p < 0.001). Although differences in diagnostic criteria for early vs. later studies did not reach statistical significance, later studies tended to use normal EEG background (p = 0.09) and absence of comorbid disorders (p = 0.09) as criteria more commonly. These findings demonstrate that seizure-freedom off medications has improved in published CAE studies after 1985. Our results are limited due to retrospective analysis. Further work is needed with prospective, controlled trials to establish factors leading to improved long-term prognosis in CAE.

Keywords: Childhood absence epilepsy; Epileptogenesis; Ethosuximide; Prognosis; Valproate.

Publication types

  • Historical Article
  • Meta-Analysis
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anticonvulsants / history
  • Anticonvulsants / therapeutic use*
  • Child
  • Child, Preschool
  • Epilepsy, Absence / drug therapy*
  • Ethosuximide / history
  • Ethosuximide / therapeutic use*
  • Female
  • History, 21st Century
  • Humans
  • Infant
  • Infant, Newborn
  • Longitudinal Studies
  • Male
  • Retrospective Studies
  • Treatment Outcome*
  • Valproic Acid / history
  • Valproic Acid / therapeutic use*

Substances

  • Anticonvulsants
  • Ethosuximide
  • Valproic Acid