Sub-symptomatic epilepsy in children with severe brain damage

Aims: to document the adult outcome for childhood onset symptomatic generalized epilepsies (SGE). Methods: We retrospectively analysed the charts of 52 children with symptomatic epilepsy from 3 – 18 yrs.The diagnosis was established according to the clinical semiology of convulsions, EEG-recordings and neuroradiological findings. General health was also monitored for at least 5 yrs. 66.5% had static encephalopathy as a result of birth trauma (of those 50% were prematurely born, and others were on time with pre/peripartal asphyxia). The others : 1 had metabolic disease, 1 had a congenital brain malformation, 1 had polytrauma with resulting coma. 2 children had nonspecific dysmyelinization, 1 had a brain tumour. AET: valproate 53%, lamotrigine 10%, phenobarbiton 10% oxcarbamazepine 3% and carbamanzepine in 6%. Monotherapy has been considered the gold standard for drug treatment of epilepsy. However there is renewed interest in polytherapy because of the advent of new drugs with fewer drug interactions and new action mechanisms and the realization that most patients with refractory epilepsy are eventually treated with drug combinations. It may be less risky to add a drug than to convert from one monotherapy to another in patients with frequent or severe seizures. Conclusions: The number of convulsive remissions was significantly reduced in all our patients.Some were seizure-free for 6 months, and those with severe refractory epilepsy had 3 -4 remisssions in 6 months, of shorter duration and the clinical picture of the convulsions was less severe and life-threatening than before. In all the children financial dependency and the degree of psychomotor retardation was marked, but the outcome of symptomatic epilepsy was good.

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