Predictors of early seizure remission in Nigerian children with newly diagnosed epilepsy

Abstract

Background: it is important to predict as soon as possible after diagnosis and starting treatment, the likely clinical course of childhood-onset epilepsy, both in terms of seizure control and even more pertinently, seizure intractability. Little is known about the factors predictive of seizure control in African children. Methods: All consecutive case s of newly-diagnosed childhood epilepsy seen over a period of two years in the Pediatric Neurology clinic, University College Hospital, Ibadan, Nigeria were prospectively followed for a period of three years to determine seizure outcomes. Remission was defined as being seizure free for at least two consecutive years. Results: A total of 170 children were enrolled but 54 defaulted and were excluded from further analysis. Twenty nine 25% attained remission while 20 (17.2%) showed signs of intractability. The remaining 67 (57.8%) showed some response to anti-epileptic drug (AED) therapy. Primary generalized epilepsy was found to be significantly associated with seizure remission and successful discontinuation of AED. Factors associated with reduced likelihood of seizure remission were remote symptomatic/cryptogenic aetiology, slow waves on electroencephalography (EEG), high seizure frequency of at least one attack/ month at presentation, failure of response to the initial AED and presence of associated neurological deficits. On logistic regression, high seizure frequency and presence of slow waves on EEG remained independent negative predictors of seizure remission. Conclusion: About one-quarter of Nigerian children with newly diagnosed epilepsy attain early seizure remission within the first three years of AED therapy. The major predictors of poor seizure control and failure of seizure remission include high seizure frequency at presentation and presence of slow waves on EEG