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group_3_presentation_1_-_epilepsy-_childhood_absence_epilepsy [2017/02/03 20:47] makdayr |
group_3_presentation_1_-_epilepsy-_childhood_absence_epilepsy [2017/02/03 23:25] makdayr |
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| ====== Prognosis and Prevention ====== | ====== Prognosis and Prevention ====== | ||
| - | **ENTER HERE KRITIKA** | + | Overall, the remission rate for CAE is 80% by early puberty, although these rates vary widely. Approximately, 11-18% of children who have CAE develop tonic-clonic seizures, which begin at puberty. If the child has tonic-clonic seizures as well as absence seizures, these are less likely to go away. However, they are usually easy to control. |
| + | Early treatment to the anti-epileptic drugs may contribute to the permanent disappearance of the seizures. Drugs may be discontinued if a child has been seizure free for two-three years, but early discontinuation may trigger seizures. | ||
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| + | A study conducted by Wirrell et al found that, in a study size of 81 children, forty-seven (65%) were in remission at the time of follow-up, which was 20.4 years on average. 17% of this population were taking AEDs but continued to have seizures, while 13% were taking AEDs and 15% had progressed to juvenile myoclonic epilepsy (JME). This ecidence suggests that when AEDs are taken, chances of remission into adulthood are high. | ||
| + | Of 81 children with CAE, 72 (89%) were contacted for follow-up. Mean age at seizure onset was 5.7 years (range, 1 to 14 years) and at follow-up was 20.4 years (range, 12 to 31 years). Forty-seven (65%) were in remission. Twelve others (17%) were not taking AEDs but continued to have seizures. Thirteen (18%) were taking AEDs; five were seizure-free over the last year (in four of these a trial without AEDs had previously failed). Fifteen percent of the total cohort had progressed to juvenile myoclonic epilepsy (JME). Multiple clinical and EEG factors were examined as predictors of outcome. Factors predicting no remission (p < 0.05) included cognitive difficulties at diagnosis, absence status prior to or during AED treatment, development of generalized tonic clonic or myoclonic seizures after onset of AEDs, abnormal background on initial EEG, and family history of generalized seizures in first-degree relatives. | ||
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| + | Furthermore, in a retrospective analysis of a cohort of 163 patients, 64 of which had CAE, were followed for a duration of 25.8 years. It was found that 58% of patients with CAE were in remission, and had been seizure free for a period of at least two years. | ||
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| - | For patients who refuse pharmacological treatment, a Ketogenic diet, special high fat, low-carbohydrate diet, is available as an alternative regimen to control and manage seizures. **(KRITIKA ADD STUFF HERE)** | + | For patients who refuse pharmacological treatment, a Ketogenic diet, special high fat, low-carbohydrate diet, is available as an alternative regimen to control and manage seizures. The ketogenic diet may prove to be beneficial in comparison to the antiepileptic drugs. Studies find that approximately 50% reduction in the frequency of seizures. In a recent study of 317 Chinese children, 35.0%, 26.2%, and 18.6% children showed >50% seizure reduction at three, six, and 12 months, respectively. Furthermore, in a systematic review conducted by Keene et al, with a total collective population of 972, an average of 15.6% of the patients had become seizure-free at the 6-month mark, and 33.0% had more than 50% reduction in seizure frequency after incorporating the ketogenic diet. |
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