Very long-term outcomes of childhood onset epilepsy reported

By Shreeya Nanda, Senior medwireNews Reporter

A study in Epilepsia presents seizure remission outcomes as well as detailed clinical and neurological findings from a minimum 45-year follow-up of a Finnish cohort of individuals with childhood-onset epilepsy.

Of the 245 original participants of the Turku Adult Childhood Onset Epilepsy (TACOE) study, 133 of 179 surviving subjects were available for the analysis conducted after 45 years of follow-up. Among these, 61% were in 10-year remission as assessed at last follow-up, while 43% had achieved remission off medication.

Matti Sillanpää (University of Turku) and colleagues found that aetiology “strongly influences” seizure outcomes, with significantly more patients with idiopathic and cryptogenic disease attaining terminal remission compared with symptomatic cases, at a respective 95% and 72% versus 47%.

The difference was “even more striking” with respect to remission off medication, say the researchers, achieved by 81% of idiopathic cases, 63% of cryptogenic cases and 25% of those with symptomatic disease.

At the 50-year follow-up timepoint, Sillanpää et al conducted neurological and clinical assessments in 51 of 73 available TACOE participants with uncomplicated epilepsy, defined as those without major neurological impairment at the onset of epilepsy, and 52 of 78 controls matched at intake for age, gender and domicile.

Abnormal neurological indications were present in a significantly higher proportion of patients with epilepsy than controls, with 39% versus 13% presenting abnormal central nervous system signs. Mortality rates between 1992 and 2012 (9 vs 1%) were also higher in the former group.

Moreover, although abnormalities on 3T magnetic resonance imaging (MRI) were observed in a substantial proportion of both groups, patients with epilepsy were twice as likely to present with abnormalities as controls.

Epilepsy patients also had a 2.5-times increased risk of developing 3T MRI-detected markers of cerebrovascular disease. This finding is of particular interest given that the groups were comparable with respect to serum markers of cerebrovascular disease and other risk factors, such as smoking and obesity, say the study authors.

“This suggests that it is the epilepsy, including the underlying etiology, seizures, and treatment, that may be responsible for these early changes”, they write, adding that “time will tell whether these imaging findings will translate into an increased rate of clinically evident disease such as stroke or cognitive decline.”

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