Historical trend toward improved long-term outcome in childhood absence epilepsy - PubMed (original) (raw)

Meta-Analysis

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

Elliot Morse et al. Epilepsy Res. 2019 May.

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.

Copyright © 2019 Elsevier B.V. All rights reserved.

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Conflict of interest statement

Disclosures of Conflicts of Interest

The authors have no conflicts of interest to disclose.

Figures

Figure 1

Figure 1. Seizure-free outcome off medications has improved over time, and is better following treatment with ethosuximide or valproate.

A. Percent of patients experiencing seizure freedom off medications plotted with respect to year of study publication (Table 1). Studies published prior to 1975 had significantly lower rates of seizure freedom than those published after 1985 (p < 0.001, two-tailed t-test). Note: there are 2 studies presented that were published in 1963, with cure rates of 37.5% and 38%, therefore the datapoint at this timepoint consists of 2 overlapping datapoints. B. Percent of subjects experiencing seizure freedom overall (Seizure free all), while on medication, and once off medication, in patients treated with ethosuximide (ESX) or valproate (VPA) versus all other medications. A significantly higher rate of seizure freedom was found in all three groups in patients treated with ESX or VPA compared to those treated with other medications. * p < 0.001, chi-squared analysis (see text).

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