Bhagyalakshmi, S (2012) Clinical Profile of Intractable Epilepsy in Children. Masters thesis, Stanley Medical College, Chennai.
|
Text
200700212bhagyalakshmi.pdf Download (1MB) | Preview |
Abstract
INTRODUCTION: Intractable epilepsies constitute a small but a significant proportion of all epilepsies in childhood. Intractable epilepsy is a major health problem in many areas of the world. Chronic uncontrolled epilepsy can have serious medical consequences including an increased risk of mood disorders, physical injuries and sudden unexpected death. Intractable seizures are a major economic burden to the society. I n majority of the children epilepsy remains a mild disorder with 60-80% remitting spontaneously or with treatment. Seizure control remains poor in 10 - 20%17. A prompt diagnosis of refractoriness is of paramount importance for consideration of other therapies such as surgery. Early surgical intervention when successful might also prevent or reverse psychosocial consequences and cognitive impairment of uncontrolled seizures during critical periods of development. AIMS AND OBJECTIVES: 1. To study the clinical profile of intractable seizures. 2. To determine the clinical predictors of intractable seizures. DISCUSSION: The prevalence of intractable seizures was 10.53% in our study. Camfield et al showed the prevalence of intractable seizures to be 8% in his studies. Sillanpaa in his study showed the prevalence of intractable seizures to be 22%. Medically intractable seizures is estimated to develop in 10- 20% of children with epilepsy. In our study 67.5% of the children were males. There was a significant male preponderance in both the groups. Similar results were seen by Javad Abhondian et al (76.5%). Mallik et al also showed a male preponderance in his study. However male sex was not significantly associated with intractable seizures in our study. In our study the incidence of daily seizures was 50.8% in the case group. A similar result was shown by Manoj et al1 in his case group (50%). Javad et al showed the incidence of daily seizures to be 66.7% in his cases. The occurrence of weekly seizures in our study was 19% and these matched well with Manoj et al1 studies (20%). 30.2% of our cases had monthly seizures and our results matched well with Manoj et al who showed the occurrence of monthly seizures to be 30%. The commonest seizure type in our study was generalized seizures. These results were also shown by Chawla et al, Ohtsuka et al and Berg et al in their studies. A mong the seizure types Myoclonic seizures proved to be an important predictor of intractability in our study. A similar result was shown by Chawla et al, Malik et al and Javad et al4 in their studies. Eriksson et al, Udani et al and Berg et al stated that myoclonic seizures/infantile spasms have the poorest seizure control. 82.5% of the cases were on 3 AED’s, 11.1% on 4 AED’s and 6.3% on 5 AED. 4.8% of the controls were on 3 AED’s. None of the children in the control group was on more than 3 AED. SUMMARY OF THE RESULTS AND CONCLUSIONS: The following factors were found to be significantly associated with Intractable Epilepsy in our study Age of onset < 1 year, Status epilepticus, Neonatal seizures, Myoclonic seizures, Birth asphyxia, Developmental delay, Abnormal neurological examination, Microcephaly, Language delay, Quadriplegia, Abnormal EEG, Abnormal MRI scan , Remote symptomatic etiology. C hildren presenting with Myoclonic seizures, Age of onset <1 year, Status epilepticus, Neonatal seizures, Birth asphyxia, Developmental delay, Microcephaly, Abnormal findings on EEG and MRI must be identified early and referred to a specialist for optimization of pharmacotherapy, considering early surgery in selective cases and trial of the newer modalities of treatment. Early identification is also important for parental counseling regarding the nature of the disease and importance of compliance to medications. In our study the commonest cause of Intractable Epilepsy was perinatal asphyxia. Perinatal asphyxia can be prevented by good nutrition during pregnancy, regular antenatal checkups with detection of high risk pregnancy, promoting hospital deliveries and prompt resuscitation of newborn when required. Status epilepticus is also a significant risk factor for Intractable Epilepsy. It must be prevented by counseling mothers regarding compliance to drugs and to seek medical facilities for early intervention when seizures occur.
| Item Type: | Thesis (Masters) |
|---|---|
| Uncontrolled Keywords: | Clinical Profile ; Intractable Epilepsy ; Children. |
| Subjects: | MEDICAL > Paediatrics |
| Depositing User: | Ravindran C |
| Date Deposited: | 16 Apr 2018 10:30 |
| Last Modified: | 16 Apr 2018 11:24 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/7019 |
Actions (login required)
 |
View Item |
