Natural history of epilepsy in a cohort of 127 children in Santiago de Cuba: 2 years follow–up

Abstract

A hospital based study was conducted in Hospital Infantil Sur, Department of Neurology (Santiago de Cuba) in a newly diagnosed cohort of 127 epileptic patients that were followed up in a period of 2 years. Each patient received an individualized treatment, following the ILAE criteria of seizure and syndrome classification with regular follow–up in outpatient department every 3 months. A detailed characterization of clinical and epidemiologic variables with predictor value for remission, relapse or refractoriness was the main purpose of this prospective study. A terminal remission of 33.85 % (43 patients) was achieved; meanwhile 48 suffered a relapse within the first 6 months but remitted in the last 18 months. A total of 36 cases were considered drug–resistant (28.34 %) that included 16 Symptomatic focal complex, 15 severe syndromes and 5 generalized idiopathic. Severe generalized syndromes (23 cases, 18.11 %) were the main source, as expected, of refractoriness, however, cases of generalized, idiopathic epilepsies like absences, were difficult to control. Focal idiopathic syndromes predominated with 37.79 % (48 cases) with good control in their majority. Diverse comorbidities were present in majorities of cases and sepsis of CNS and respiratory sepsis interfered with the good control of seizures and were an important associated risk factor for refractoriness, as well as delayed motor development and mental retardation. Prenatal hypertension, prematurity both in age and weight were found to have influenced the outcome negatively. Many as 40.94 % of these cases have increased number of crisis at onset (> 1 per week) and seem to influence the outcome; however, 2-year period is of limited value. It is strongly recommended to get started in our country a unified, nationwide, population based study of epileptic patients with a long term follow up for a meaningful answer of prevalence of childhood epilepsy and its clinical profile.