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MONTREAL — Children with epilepsy who are also mentally retarded can become seizure free, and more than half can eventually discontinue seizure medication, although repeated efforts may be required to reach those goals, reported Dr. Carol Camfield at the 10th International Child Neurology Congress.
Because children with epilepsy and mental retardation have a poor prognosis for seizure control, physicians and parents may be reluctant to discontinue antiepileptic drugs (AEDs), noted Dr. Camfield, of Dalhousie University and the IWK Health Center, Halifax, Nova Scotia. The result is that these patients may unnecessarily remain on AEDs.
Dr. Camfield—working in collaboration with her husband Dr. Peter Camfield, of the same affiliation—for more than 20 years followed 692 children in Nova Scotia aged 1 month to 16 years who were diagnosed with epilepsy between 1977 and 1985. Children with a mental handicap (IQ less than 70) were studied to establish whether they could become seizure free long enough to discontinue AEDs, and were then followed to see how long they could remain seizure free without AEDs.
Twenty-one percent of the children with epilepsy had an IQ of less than 70 at the time of diagnosis. Of these patients, 117 children with epilepsy and mental retardation were still alive at the end of the follow-up period, Dr. Camfield reported.
Of this group, 45% were deemed to be severely mentally disabled, 26% moderately disabled, and 28% mildly disabled. Epilepsy started earlier in children with a low IQ, compared with children of normal intelligence (3.3 years vs. 7.0 years), with 40% having a seizure within the first year of life.
Sixty-nine (59%) of the epilepsy/low IQ subgroup became seizure free and attempted to end AED therapy. Of these, 35 (51%) were able to discontinue AEDs on the first attempt without seizure recurrence. Eleven others achieved the goal after two tries, and four were able to discontinue AEDs after three tries. Overall, 61% of the children with epilepsy and low IQ were able to discontinue the medications successfully, compared with 73% of children with epilepsy of normal intelligence. However, it took an average of more than 5 years to make the initial try.
Those children with more severe mental retardation, status epilepticus, neurologic deficits, and poor mobility were less likely to discontinue AEDs. Those with symptomatic partial epilepsies were more likely to attempt discontinuation than were those with secondary generalized epilepsies.
“The practice had been to keep any child on AEDs for 2–4 years once they became seizure free—these children were clearly kept on longer,” commented Dr. Camfield.
MONTREAL — Children with epilepsy who are also mentally retarded can become seizure free, and more than half can eventually discontinue seizure medication, although repeated efforts may be required to reach those goals, reported Dr. Carol Camfield at the 10th International Child Neurology Congress.
Because children with epilepsy and mental retardation have a poor prognosis for seizure control, physicians and parents may be reluctant to discontinue antiepileptic drugs (AEDs), noted Dr. Camfield, of Dalhousie University and the IWK Health Center, Halifax, Nova Scotia. The result is that these patients may unnecessarily remain on AEDs.
Dr. Camfield—working in collaboration with her husband Dr. Peter Camfield, of the same affiliation—for more than 20 years followed 692 children in Nova Scotia aged 1 month to 16 years who were diagnosed with epilepsy between 1977 and 1985. Children with a mental handicap (IQ less than 70) were studied to establish whether they could become seizure free long enough to discontinue AEDs, and were then followed to see how long they could remain seizure free without AEDs.
Twenty-one percent of the children with epilepsy had an IQ of less than 70 at the time of diagnosis. Of these patients, 117 children with epilepsy and mental retardation were still alive at the end of the follow-up period, Dr. Camfield reported.
Of this group, 45% were deemed to be severely mentally disabled, 26% moderately disabled, and 28% mildly disabled. Epilepsy started earlier in children with a low IQ, compared with children of normal intelligence (3.3 years vs. 7.0 years), with 40% having a seizure within the first year of life.
Sixty-nine (59%) of the epilepsy/low IQ subgroup became seizure free and attempted to end AED therapy. Of these, 35 (51%) were able to discontinue AEDs on the first attempt without seizure recurrence. Eleven others achieved the goal after two tries, and four were able to discontinue AEDs after three tries. Overall, 61% of the children with epilepsy and low IQ were able to discontinue the medications successfully, compared with 73% of children with epilepsy of normal intelligence. However, it took an average of more than 5 years to make the initial try.
Those children with more severe mental retardation, status epilepticus, neurologic deficits, and poor mobility were less likely to discontinue AEDs. Those with symptomatic partial epilepsies were more likely to attempt discontinuation than were those with secondary generalized epilepsies.
“The practice had been to keep any child on AEDs for 2–4 years once they became seizure free—these children were clearly kept on longer,” commented Dr. Camfield.
MONTREAL — Children with epilepsy who are also mentally retarded can become seizure free, and more than half can eventually discontinue seizure medication, although repeated efforts may be required to reach those goals, reported Dr. Carol Camfield at the 10th International Child Neurology Congress.
Because children with epilepsy and mental retardation have a poor prognosis for seizure control, physicians and parents may be reluctant to discontinue antiepileptic drugs (AEDs), noted Dr. Camfield, of Dalhousie University and the IWK Health Center, Halifax, Nova Scotia. The result is that these patients may unnecessarily remain on AEDs.
Dr. Camfield—working in collaboration with her husband Dr. Peter Camfield, of the same affiliation—for more than 20 years followed 692 children in Nova Scotia aged 1 month to 16 years who were diagnosed with epilepsy between 1977 and 1985. Children with a mental handicap (IQ less than 70) were studied to establish whether they could become seizure free long enough to discontinue AEDs, and were then followed to see how long they could remain seizure free without AEDs.
Twenty-one percent of the children with epilepsy had an IQ of less than 70 at the time of diagnosis. Of these patients, 117 children with epilepsy and mental retardation were still alive at the end of the follow-up period, Dr. Camfield reported.
Of this group, 45% were deemed to be severely mentally disabled, 26% moderately disabled, and 28% mildly disabled. Epilepsy started earlier in children with a low IQ, compared with children of normal intelligence (3.3 years vs. 7.0 years), with 40% having a seizure within the first year of life.
Sixty-nine (59%) of the epilepsy/low IQ subgroup became seizure free and attempted to end AED therapy. Of these, 35 (51%) were able to discontinue AEDs on the first attempt without seizure recurrence. Eleven others achieved the goal after two tries, and four were able to discontinue AEDs after three tries. Overall, 61% of the children with epilepsy and low IQ were able to discontinue the medications successfully, compared with 73% of children with epilepsy of normal intelligence. However, it took an average of more than 5 years to make the initial try.
Those children with more severe mental retardation, status epilepticus, neurologic deficits, and poor mobility were less likely to discontinue AEDs. Those with symptomatic partial epilepsies were more likely to attempt discontinuation than were those with secondary generalized epilepsies.
“The practice had been to keep any child on AEDs for 2–4 years once they became seizure free—these children were clearly kept on longer,” commented Dr. Camfield.