Abstracts

Rationale:
Seizure resolution is the hallmark of childhood absence epilepsy (CAE).  Though seizures typically resolve by the end of elementary school, not all patients follow this plan and seizure resolution can vary widely.  We wanted to understand some of the factors that were responsible for this variability.  For this project, we examined > 12 intrinsic and extrinsic factors, including age of seizure onset, family history of seizures, comorbidities and more, that can affect seizure outcome in a cohort of CAE patients with classic 3 Hz bursting in a community-based practice.
Method:
Patients were selected that met standard criteria for CAE.  There were followed prospectively with serial, biannual EEGs.  To evaluate seizure outcome, > 12 different factors selected from 6 different clinical and EEG areas were analyzed.  These areas included seizure prodrome and diagnosis, personal history, comorbidities, treatment problems, other seizure types and early EEG changes.  All patients responded to standard anti--epileptic treatment with decreasing clinical seizures.
Results:
We studied 34 CAE patients with 3 Hz bursts ranging in age from 8-19 yrs. old (mean= 12.4).  Seizure onset ranged from 4.5-11 yrs. (mean=  7.2), but seizure resolution varied widely from 1.3-10 yrs. (mean= 3.8).  Patients with early onset seizures (4-7 yrs.) had more persistent seizure activity and prolonged EEG changes compared to patients with later onset seizures (8-11 yrs.). Patients with a family history of seizures did not differ in seizure duration compared to those with no family history.  Females had longer delays to diagnosis, 1 mon.-7 yrs. (mean= 1.3 yrs.), compared to males, 1 week-3 yrs. (mean= 5 mons.).  This diagnosis delay in females coincided with a longer seizure course.  School performance was also an important factor.  Patients with ADD or learning problems were slow to resolve, while patients who were excellent students resolved faster than those who were only average or fair students.  None of our patients had myoclonic seizures, though tonic-clonic seizures and photosensitivity were observed more often in teenagers with slow to resolve seizures.  Most patients had reduced 3 Hz bursting after 2 years of treatment.  Persistent bursting or isolated frontal discharges signaled delayed in seizure resolution.
Conclusion:
Seizure resolution in CAE is affected by both intrinsic and extrinsic factors.  Early diagnosis and later seizure onset were associated with shorter seizure courses.  Learning disorders and persistent bursting on EEGs were associated with delayed seizure resolution.  Diagnosis delays in females may reflect societal biases.  Understanding the interplay of these factors suggests ways to improve seizure control in CAE patients.
Funding:
:No special funding