Early predictors of remission in children and adolescents with new-onset epilepsy: A prospective study

• Published in: Seizure (London, England) England), 2023-08, Vol.110, p.69-77
• Main Authors: Ayoub, Dana, Al-Hajje, Amal, Salameh, Pascale, Jost, Jeremy, Hmaimess, Ghassan, Nasreddine, Wassim, Jaafar, Fatima, Wazne, Jaafar, Bitar, Ribal, Sabbagh, Sandra, Boumediene, Farid, Beydoun, Ahmad
• Format: Article
• Language: English
• Subjects: Adolescent; Anticonvulsants - therapeutic use; Child; Children and adolescents; Epilepsies, Partial - drug therapy; Epilepsy - chemically induced; Epilepsy - drug therapy; Epileptogenic lesion; Humans; Intellectual and developmental delay; Life Sciences; New-onset seizures; Number of pretreatment seizures; Prospective Studies; Remission; Santé publique et épidémiologie; Seizures - drug therapy
• ISSN: 1059-1311; 1532-2688
• DOI: 10.1016/j.seizure.2023.06.007

•The likelihood of seizure remission can be predicted at the time of initial evaluation in children with new-onset seizures.•Three factors are predictive of a lower probability of remission: presence and severity of intellectual and developmental delay, detection of an epileptogenic lesion on brain MRI, and a higher number of pretreatment seizures.•Intellectual and developmental delay is the most important predictor of failure to achieve remission. This study aims to identify predictive factors of a two-year remission (2YR) in a cohort of children and adolescents with new-onset seizures based on baseline clinical characteristics, initial EEG and brain MRI findings. A prospective cohort of 688 patients with new onset seizures, initiated on treatment with antiseizure medication was evaluated. 2YR was defined as achieving at least two years of seizure freedom during the follow-up period. Multivariable analysis was performed and recursive partition analysis was utilized to develop a decision tree. The median age at seizure onset was 6.7 years, and the median follow-up was 7.4 years. 548 (79.7%) patients achieved a 2YR during the follow up period. Multivariable analysis found that presence and degree of intellectual and developmental delay (IDD), epileptogenic lesion on brain MRI and a higher number of pretreatment seizures were significantly associated with a lower probability of achieving a 2YR. Recursive partition analysis showed that the absence of IDD was the most important predictor of remission. An epileptogenic lesion was a significant predictor of non-remission only in patients without evidence of IDD, and a high number of pretreatment seizures was a predictive factor in children without IDD and in the absence of an epileptogenic lesion. Our results indicate that it is possible to identify patients at risk of not achieving a 2YR based on variables obtained at the initial evaluation. This could allow for a timely selection of patients who require close follow-up, consideration for neurosurgical intervention, or investigational treatments trials.