Predictors of drug-resistant epilepsy in childhood epilepsy syndromes: A subgroup analysis from a prospective cohort study

IF 6.6 1区医学 Q1 CLINICAL NEUROLOGY Epilepsia Pub Date : 2024-08-16 DOI:10.1111/epi.18100

Dana Ayoub, Fatima Jaafar, Amal Al-Hajje, Pascale Salameh, Jeremy Jost, Ghassan Hmaimess, Jaafar Wazne, Zein Ismail-Fawaz, Sandra Sabbagh, Farid Boumediene, Ahmad Beydoun

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Abstract

Objective

Previous studies assessing factors associated with drug-resistant epilepsy (DRE) were constrained by their amalgamation of all epilepsy syndromes in their analyses and the absence of uniform criteria for defining DRE. Our objective was to identify predictors of DRE among the four primary childhood epilepsy syndrome groups within a cohort of children with new onset seizures, using the International League Against Epilepsy (ILAE) definition of DRE and the recent classification of epilepsies.

Methods

This is a prospective study of 676 children with new onset seizures initiated on antiseizure medication. Patients were monitored for the occurrence of DRE according to the ILAE criteria and were categorized into one of four epilepsy groups: self-limited focal epilepsies (SeLFEs), genetic generalized epilepsies (GGEs), developmental epileptic encephalopathies (DEEs), and focal epilepsies. Cox regression analysis was performed to identify predictors of DRE within each epilepsy group.

Results

Overall, 29.3% of children were classified as having DRE, with the highest incidence observed among children diagnosed with DEEs (77.7%), followed by focal epilepsies (31.5%). Across the entire cohort, predictors of DRE included the presence of an epileptogenic lesion, a higher pretreatment number of seizures, experiencing multiple seizure types, presence and severity of intellectual and developmental delay, myoclonus, and younger age at epilepsy onset. Within the GGEs, only a younger age at seizure onset and experiencing multiple seizure types predicted DRE. Among focal epilepsies, predictors of DRE included the presence of an epileptogenic lesion, experiencing multiple seizure types, and having a greater number of pretreatment seizures. Within the DEEs, predictors of DRE were the occurrence of tonic seizures. Predictors of DRE within SeLFEs could not be identified.

Significance

This study indicates that different epilepsy syndromes are associated with distinct predictors of drug resistance. Anticipation of drug resistance within various groups is feasible using accessible clinical variables throughout the disease course.

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儿童癫痫综合征耐药性癫痫的预测因素：一项前瞻性队列研究的分组分析。

研究目的以往评估耐药性癫痫（DRE）相关因素的研究受到了限制，因为它们在分析中合并了所有癫痫综合征，而且缺乏定义 DRE 的统一标准。我们的目标是采用国际抗癫痫联盟（ILAE）对 DRE 的定义和最新的癫痫分类，在新发癫痫儿童队列中确定四个主要儿童癫痫综合征组中 DRE 的预测因素：这是一项前瞻性研究，研究对象是 676 名开始服用抗癫痫药物的新发癫痫发作儿童。根据ILAE标准监测患者是否出现DRE，并将其分为四类癫痫：自限性局灶性癫痫（SeLFEs）、遗传性全身性癫痫（GGEs）、发育性癫痫性脑病（DEEs）和局灶性癫痫。对每个癫痫组别进行了Cox回归分析，以确定DRE的预测因素：总体而言，29.3%的儿童被归类为患有DRE，其中诊断为DEEs的儿童发病率最高（77.7%），其次是局灶性癫痫（31.5%）。在整个队列中，预测 DRE 的因素包括存在致痫病灶、治疗前癫痫发作次数较多、经历多种癫痫发作类型、存在智力和发育迟缓及其严重程度、肌阵挛以及癫痫发病年龄较小。在普通癫痫患者中，只有发病年龄较小和经历多种癫痫发作类型才能预测 DRE。在局灶性癫痫中，预测 DRE 的因素包括存在致痫病灶、经历多种发作类型以及治疗前发作次数较多。在DEEs中，强直性发作是DRE的预测因素。在 SeLFEs 中，无法确定 DRE 的预测因素：这项研究表明，不同的癫痫综合征与不同的耐药性预测因素有关。利用整个病程中可获得的临床变量来预测不同群体的耐药性是可行的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Epilepsia 医学-临床神经学

CiteScore

10.90

自引率

10.70%

发文量

319

审稿时长

2-4 weeks

期刊介绍： Epilepsia is the leading, authoritative source for innovative clinical and basic science research for all aspects of epilepsy and seizures. In addition, Epilepsia publishes critical reviews, opinion pieces, and guidelines that foster understanding and aim to improve the diagnosis and treatment of people with seizures and epilepsy.