Risk Factors of Intractable Epilepsy in Children with Cerebral Palsy. Risk factors and intractable epilepsy.
Iranian Journal of Child Neurology,
Vol. 15 No. 4 (2021),
1 October 2021
https://doi.org/10.22037/ijcn.v15i3.31556
Abstract
Objectives: We aimed to determine the risk factors predicting the development of intractable epilepsy in children with cerebral palsy taking into consideration perinatal characteristics; seizure semiology, imaging, and EEG findings.
Materials & Methods: This descriptive, retrospective, case-control study was conducted on 106 children with CP and epilepsy in the period from 2015-2020. They were 46 children with CP and intractable epilepsy and 60 children with CP and controlled epilepsy. Data were retrieved through medical files review. We collected and analyzed data related to demographics, clinical characteristics, perinatal history, etiology of seizure and CP, seizure semiology, intellectual functions, therapeutic options, brain imaging, and EEG findings.
Results: We established a model of the most important risk factors that are predictive of intractable epilepsy in children with CP. This predictive model includes the additive effect of a poor Apgar score at 5 minutes, the presence of neonatal seizures, focal epilepsy, and focal slowing on the EEG background (Area under the receiver operating characteristic of 0.810).
conclusion: Our results are helpful to identify intractable epilepsy in children with cerebral palsy with further support by offering early therapeutic interventions to reduce the burden of refractory seizures in children with CP.
Keywords:
- Risk factors-Intractable epilepsy-Cerebral palsy-Children.
How to Cite
Yehia Hamed, A. M., Abdelaziz Suliman, H., Elsayed Abdulsamea, S., Mohamed Kamal, N., Hamed AL-SHOKRAY, A., Obada Ibrahim, A. ., … Elsadek , A. E. . (2021). Risk Factors of Intractable Epilepsy in Children with Cerebral Palsy.: Risk factors and intractable epilepsy. Iranian Journal of Child Neurology, 15(4). https://doi.org/10.22037/ijcn.v15i3.31556
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23. Kulak W, SobaniecW(2003) Risk factors and prognosis of epilepsy in children with cerebral palsy in North-Eastern Poland. Brain and Development 25:499–506.
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27- Carlsson M, Hagberg G, Olsson I. Clinical and aetiological aspects of epilepsy in children with cerebral palsy. Dev Med Child Neurol 2003; 45:371-6.
28-Shevell MI, Dagenais L, Hall N, Consortium R. Comorbidities in cerebral palsy and their relationship to neurologic subtype and GMFCS level. Neurology. 2009;72(24):2090-2096.
29- Huang L, Li S, He D, Bao W, Li L. A predictive risk model for medical intractability in epilepsy. Epilepsy Behav. 2014; 37:282-286.
30- Wirrell E, Wong-Kisiel L, Mandrekar J, Nickels K. Predictors and course of medically intractable epilepsy in young children presenting before 36 months of age: a retrospective, population based study. Epilepsia. 2012; 53(9):1563-1569.
31- Nelson KB, Ellenberg JH.Antecedents of seizure disorders in early childhood. American Journal of Diseasesof Children. 1986; 140:1053-1061.
32-Novak I, Hines M, Goldsmith S, Barclay R. Clinical prognostic messages from a systematic review on cerebral palsy. Pediatrics. 2012; 130(5):e1285-e1312.
33- Ronen GM, Buckley D, Penney S, Streiner DL. Long-term prognosis in children with neonatal seizures: A populationbased study. Neurology.2007; 69:1816-1822.
34- Senbil N, Sonel B, Aydin OF, Gurer YK. Epileptic and nonepileptic cerebral palsy: EEG and cranial imaging findings. Brain Dev. 2002; 24(3):166-169.
35. Zafeiriou DI, Kontopoulos EE, Tsikoulas I. Characteristics and prognosis of epilepsy in children with cerebral palsy. J Child Neurol. 1999; 14(5):289-294.
36. Delgado MR, Riela AR, Mills J, Pitt A, Browne R. Discontinuation of antiepileptic drug treatment after two seizure-free years in children with cerebral palsy. Pediatrics. 1996; 97(2):192-197.
37. Cockerell OC, Johnson AL, Sander JW, Shorvon SD. Prognosis of epilepsy: a review and further analysis of the first nine years of the British National General Practice Study of Epilepsy, a prospective population-based study. Epilepsia. 1997; 38(1):31-46.
38. Elwes RD, Johnson AL, Shorvon SD, Reynolds EH. The prognosis for seizure control in newly diagnosed epilepsy. N Engl J Med. 1984; 311(15):944-947.
39-- De Negri M. Electrical status epilepticus in childhood: neuropsychological
impairment and therapeutic management. Dev Med Child Neurol. 1994; 36(2):183-186.
42. Arts WF, Geerts AT, Brouwer OF, Boudewyn Peters AC, Stroink H, van Donselaar CA. The early prognosis of epilepsy in childhood: the prediction of a poor outcome. The Dutch study of epilepsy in childhood. Epilepsia. 1999; 40(6):
726-734.
43. Berg AT, Shinnar S, Levy SR, Testa FM, Smith-Rapaport S, Beckerman B. Early development of intractable epilepsy in children: a prospective study. Neurology. 2001; 56(11):1445-1452.
44. Ko TS, Holmes GL. EEG and clinical predictors of medically intractable childhood epilepsy. Clin Neurophysiol. 1999; 110(7):1245-1251.
45. Uvebrant P. Hemiplegic cerebral palsy. Aetiology and outcome. Acta Paediatr Scand Suppl. 1988; 345:1-100.
46. Sussova J, Seidl Z, Faber J. Hemiparetic forms of cerebral palsy in relation to epilepsy and mental retardation. Dev Med Child Neurol.1990;32(9):792-795.
2- Barkudah E, et al. Cerebral palsy: Overview of management and prognosis. https://www.uptodate.com/contents/search. Accessed July 10, 2019.
3-Oskoui, M; Coutinho, F; Dykeman, J; Jetté, N; Pringsheim, T (June 2013). "An update on the prevalence of cerebral palsy: a systematic review and meta-analysis". Developmental Medicine & Child Neurology. 55 (6): 509–19.
4. Wallace, S. J. Epilepsy in cerebral palsy. Developmental Medicine and Child Neurology 2001; 43: 713–717.
5. Gururaj, A. K., Sztriha, L., Dawodu, A. et al. CT and MR patterns of hypoxic ischemic brain damage following perinatal asphyxia. Journal of Tropical Paediatrics 2002; 48: 5–9.
6-Zelnik N, Konopnicki M, Bennett-Back O, Castel-Deutsch T, Tirosh E. Risk factors for epilepsy in children with cerebral palsy. Eur J Paediatr Neurol. 2010; 14(1):67-72.
7- Ronen GM, Buckley D, Penney S, Streiner DL. Long-term prognosis in children with neonatal seizures: a populationbased study. Neurology 2007; 69:1816–22.
8-Eherenstein V, Pedersen L, Holsteen V, Larsen H, Rothman KJ, Sørensen HT. Postterm delivery and risk for epilepsy in childhood. Pediatrics 2007; 119:554–61.
9- Fisher RS, Acevedo C, Arzimanoglou A, et al. ILAE official report: a practical clinical definition of epilepsy. Epilepsia. 2014; 55(4):475-482.
10-Fisher RS, Cross JH, French JA, et al. Operational classification of seizure types by the International League Against Epilepsy: position paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017; 58(4):522-530.
11- Kwan P, Arzimanoglou A, Berg AT, et al. Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia. 2010; 51(6):1069-1077.
12- American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, 4th edn text revision [DSM–IV-TR].
13- Laxer KD, Trinka E, Hirsch LJ, et al. The consequences of refractory epilepsy and its treatment. Epilepsy Behav. 2014; 37:59-70.
14-Kwong KL, Wong SN, So KT. Epilepsy in children with cerebral palsy. Pediatr Neurol. 1998; 19(1):31-36.
15-Sellier E, Uldall P, Calado E, et al. Epilepsy and cerebral palsy: characteristics and trends in children born in 1976-1998. Eur J Paediatr Neurol. 2012; 16(1):48-55.
16-Singhi P, Jagirdar S, Khandelwal N, Malhi P. Epilepsy in children with cerebral palsy. J Child Neurol. 2003;18(3):174-179.
17-Bruck I, Antoniuk SA, Spessatto A, Bem RS, Hausberger R, Pacheco CG. Epilepsy in children with cerebral palsy. Arq Neuropsiquiatr.2001; 59(1):35-39.
18-Mert GG, Incecik F, Altunbasak S, et al. Factors affecting epilepsy development and epilepsy prognosis in cerebral palsy.Pediatr Neurol. 2011; 45(2):89-94.
19-Latzer IT , Blumovich A, Sagi L, Uliel-Sibony S, Fattal-Valevski A.Prediction of Drug-Resistant Epilepsy in Children With Cerebral Palsy. Journal of Child Neurology, 2019. DOI: 10.1177/0883073819883157.
20- Sun Y, Vestergaard M, Pedersen CB, Christensen J, Olsen J. Apgar scores and long-term risk of epilepsy. Epidemiology. 2006; 17(3):296-301.
21. Thorngren-Jerneck K, Herbst A. Low 5-minute Apgar score: apopulation-based register study of 1 million term births. Obstet Gynecol. 2001; 98(1):65-70.
22-Odding E, Roebroeck ME, Stam HJ. The epidemiology of cerebral palsy: incidence, impairments and risk factors. Disabil Rehabil. 2006; 28(4):183-191.
23. Kulak W, SobaniecW(2003) Risk factors and prognosis of epilepsy in children with cerebral palsy in North-Eastern Poland. Brain and Development 25:499–506.
24. Gururaj AK, Sztriha L, Bener A, Dawodu A, Eapen V (2003) Epilepsy in children with cerebral palsy. Seizure 12:110–114.
25. Krageloh-Mann I, Horber V. The role of magnetic resonance imaging in elucidating the pathogenesis of cerebral palsy: a systematic review. Dev Med Child Neurol. 2007; 49(2):144-151.
26. Towsley K, Shevell MI, Dagenais L, Consortium R. Population based study of neuroimaging findings in children with cerebral palsy. Eur J Paediatr Neurol. 2011; 15(1):29-35.
27- Carlsson M, Hagberg G, Olsson I. Clinical and aetiological aspects of epilepsy in children with cerebral palsy. Dev Med Child Neurol 2003; 45:371-6.
28-Shevell MI, Dagenais L, Hall N, Consortium R. Comorbidities in cerebral palsy and their relationship to neurologic subtype and GMFCS level. Neurology. 2009;72(24):2090-2096.
29- Huang L, Li S, He D, Bao W, Li L. A predictive risk model for medical intractability in epilepsy. Epilepsy Behav. 2014; 37:282-286.
30- Wirrell E, Wong-Kisiel L, Mandrekar J, Nickels K. Predictors and course of medically intractable epilepsy in young children presenting before 36 months of age: a retrospective, population based study. Epilepsia. 2012; 53(9):1563-1569.
31- Nelson KB, Ellenberg JH.Antecedents of seizure disorders in early childhood. American Journal of Diseasesof Children. 1986; 140:1053-1061.
32-Novak I, Hines M, Goldsmith S, Barclay R. Clinical prognostic messages from a systematic review on cerebral palsy. Pediatrics. 2012; 130(5):e1285-e1312.
33- Ronen GM, Buckley D, Penney S, Streiner DL. Long-term prognosis in children with neonatal seizures: A populationbased study. Neurology.2007; 69:1816-1822.
34- Senbil N, Sonel B, Aydin OF, Gurer YK. Epileptic and nonepileptic cerebral palsy: EEG and cranial imaging findings. Brain Dev. 2002; 24(3):166-169.
35. Zafeiriou DI, Kontopoulos EE, Tsikoulas I. Characteristics and prognosis of epilepsy in children with cerebral palsy. J Child Neurol. 1999; 14(5):289-294.
36. Delgado MR, Riela AR, Mills J, Pitt A, Browne R. Discontinuation of antiepileptic drug treatment after two seizure-free years in children with cerebral palsy. Pediatrics. 1996; 97(2):192-197.
37. Cockerell OC, Johnson AL, Sander JW, Shorvon SD. Prognosis of epilepsy: a review and further analysis of the first nine years of the British National General Practice Study of Epilepsy, a prospective population-based study. Epilepsia. 1997; 38(1):31-46.
38. Elwes RD, Johnson AL, Shorvon SD, Reynolds EH. The prognosis for seizure control in newly diagnosed epilepsy. N Engl J Med. 1984; 311(15):944-947.
39-- De Negri M. Electrical status epilepticus in childhood: neuropsychological
impairment and therapeutic management. Dev Med Child Neurol. 1994; 36(2):183-186.
42. Arts WF, Geerts AT, Brouwer OF, Boudewyn Peters AC, Stroink H, van Donselaar CA. The early prognosis of epilepsy in childhood: the prediction of a poor outcome. The Dutch study of epilepsy in childhood. Epilepsia. 1999; 40(6):
726-734.
43. Berg AT, Shinnar S, Levy SR, Testa FM, Smith-Rapaport S, Beckerman B. Early development of intractable epilepsy in children: a prospective study. Neurology. 2001; 56(11):1445-1452.
44. Ko TS, Holmes GL. EEG and clinical predictors of medically intractable childhood epilepsy. Clin Neurophysiol. 1999; 110(7):1245-1251.
45. Uvebrant P. Hemiplegic cerebral palsy. Aetiology and outcome. Acta Paediatr Scand Suppl. 1988; 345:1-100.
46. Sussova J, Seidl Z, Faber J. Hemiparetic forms of cerebral palsy in relation to epilepsy and mental retardation. Dev Med Child Neurol.1990;32(9):792-795.
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