Article
Long-term seizure outcomes in adults with childhood-onset epilepsy are excellent, according to a study published in the November issue of Epilepsia. The study found that while patients with childhood onset had excellent remission rates in adulthood, long-term results depending on etiology did raise concerns, most notably in cerebrovascular disease. “The presence of imaging abnormalities suggestive of vascular disease may put these subjects at higher risk for clinically evident stroke and cognitive changes as they age,” said Matti Sillanpää, MD, and colleagues. Dr. Sillanpää is a Senior Research Scientist at the University of Turku in Finland.
A population-based cohort of 245 patients with childhood-onset epilepsy was assessed for outcome at 45 years. In addition, 51 of 78 surviving subjects with uncomplicated epilepsy (ie, no neurologic impairment at onset) and 52 of 99 originally matched controls participated in a detailed evaluation that included EEG, imaging, and laboratory studies at 50 years.
Of the 179 surviving subjects, 61% were in terminal 10-year remission and 43% were in remission off medications. At 45 years, 95% of the idiopathic group, 72% of the cryptogenic group, and 47% of the remote symptomatic group were in terminal remission. Abnormal neurologic signs were significantly more common in subjects with uncomplicated epilepsy than in controls. Mortality during the period from 1992 to 2012 was higher in subjects (9%) than in controls (1%). The rate of MRI abnormalities was higher in subjects than in controls (risk ratio, 2.0), specifically including findings indicative of cerebrovascular disease.
In the 50-year follow-up study, the 47 remaining willing patients who had no neurologic impairment at onset were compared with a group of 50 controls. The previously epileptic group was shown to be more susceptible to neurologic disorders than the controls (73% vs 55%, respectively).
This finding is consistent with the MRI results of the subjects when examined at middle age, which showed a significantly higher rate of neurologic abnormalities on examinations than controls did. These changes, while often present in the general population, had an earlier onset in the epileptic population. These findings suggest that underlying etiology, seizures, and treatment may be responsible for these changes.
This study’s significance lies in the long and continuing duration of the follow-up. The extended study time allowed researchers to compare development between patients with epilepsy and the general population. As the epilepsy and control groups reach an age characteristic of cerebrovascular risk, further analysis is needed to determine if the concerns about MRI results translate to disease, said Dr. Sillanpää.
—Adaeze Stephanie Onyechi