Long‐term seizure remission in childhood absence epilepsy: Might initial treatment matter?
Summary Objective Examine the possible association between long‐term seizure outcome in childhood absence epilepsy (CAE) and the initial treatment choice. Methods Children with CAE were prospectively recruited at initial diagnosis and followed in a community‐based cohort study. Children presenting w...
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| Veröffentlicht in: | Epilepsia (Copenhagen) 2014-04, Vol.55 (4), p.551-557 |
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| creator | Berg, Anne T. Levy, Susan R. Testa, Francine M. Blumenfeld, Hal |
| description | Summary
Objective
Examine the possible association between long‐term seizure outcome in childhood absence epilepsy (CAE) and the initial treatment choice.
Methods
Children with CAE were prospectively recruited at initial diagnosis and followed in a community‐based cohort study. Children presenting with convulsive seizures, significant imaging abnormalities, or who were followed |
| doi_str_mv | 10.1111/epi.12551 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3999182</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1524401444</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4761-8b263a2a7dfdc19456cf7f9304bd26bb8c2c81b2c5f7adb6e36d9b9fcb53a7d53</originalsourceid><addsrcrecordid>eNqNkU9rFDEchoMo7bb20C8gAS_2MG3-ThIPSilVCyt60JsQkkxmN2Vmsk1mLNtTP4Kf0U9itluLFQRzySFPnvzyvgAcYnSMyzrxq3CMCef4CZhhTmSFcS2eghlCmFaKS7QL9nK-RAiJWtAdsEsYLzyRM_BtHofFz9sfo089zD7cTMnD5PuQc4gDDAN0y9A1yxgbaGz2g_OwPNf5VV6_hh_DYjkWKIzBdHBM3oy9H0bYm7EI3z4Hz1rTZX9wv--Dr-_Ov5x9qOaf3l-cnc4rx0SNK2lJTQ0xomkbhxXjtWtFqyhitiG1tdIRJ7EljrfCNLb2tG6UVa2znJZLnO6DN1vvarK9b1wZIZlOr1LoTVrraIJ-fDKEpV7E75oqpbAkRfDqXpDi1eTzqEsAznedGXycsi6hMoYwY-w_UCwlpkJsrC__Qi_jlIaSxB2FlGByIzzaUi7FnJNvH-bGSG_q1SVvfVdvYV_8-dEH8nefBTjZAtelovW_Tfr888VW-QvfqrGM</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1518097484</pqid></control><display><type>article</type><title>Long‐term seizure remission in childhood absence epilepsy: Might initial treatment matter?</title><source>MEDLINE</source><source>Wiley Online Library Free Content</source><source>Access via Wiley Online Library</source><source>IngentaConnect Free/Open Access Journals</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Berg, Anne T. ; Levy, Susan R. ; Testa, Francine M. ; Blumenfeld, Hal</creator><creatorcontrib>Berg, Anne T. ; Levy, Susan R. ; Testa, Francine M. ; Blumenfeld, Hal</creatorcontrib><description>Summary
Objective
Examine the possible association between long‐term seizure outcome in childhood absence epilepsy (CAE) and the initial treatment choice.
Methods
Children with CAE were prospectively recruited at initial diagnosis and followed in a community‐based cohort study. Children presenting with convulsive seizures, significant imaging abnormalities, or who were followed <5 years were excluded. Early outcomes included success of initial medication, early remission, and pharmacoresistance. The primary long‐term outcome was complete remission: ≥5 years both seizure free and medication free. Survival methods were used for analyses.
Results
The first medication was ethosuximde (ESM) in 41 (69%) and valproic acid (VPA) in 18 (31%). Initial success rates were 59% (ESM) and 56% (VPA). Early remission and pharmacoresistance were similar in each group. Apart from atypical electroencephalography (EEG) features (61% [VPA], 17% [ESM]), no clinical features varied substantially between the treatment groups. Complete remission occurred in 31 children (76%) treated with ESM and 7 (39%) who received VPA (p = 0.007). Children with versus without atypical EEG features were less likely to enter complete remission (50% vs. 71%, p = 0.03). In a Cox regression, ESM was associated with a higher rate of complete remission than VPA (hazards ratio [HR] 2.5, 95% confidence interval [CI] 1.1–6.0; p = 0.03). Atypical EEG features did not independently predict outcome (p = 0.15). Five‐year and 10‐year remission, regardless of continued treatment, occurred more often in children initially treated with ESM versus VPA.
Significance
These findings are congruent with results of studies in genetic absence models in rats and provide preliminary evidence motivating a hypothesis regarding potential disease‐modifying effects of ESM in CAE.
A PowerPoint slide summarizing this article is available for download in the Supporting Information section here.</description><identifier>ISSN: 0013-9580</identifier><identifier>EISSN: 1528-1167</identifier><identifier>DOI: 10.1111/epi.12551</identifier><identifier>PMID: 24512528</identifier><identifier>CODEN: EPILAK</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Absence seizures ; Antiepileptic drugs ; Child ; Child, Preschool ; Cohort Studies ; Comparative effectiveness ; Confidence intervals ; Disease modification ; Electroencephalography ; Electroencephalography - trends ; Epilepsy, Absence - diagnosis ; Epilepsy, Absence - physiopathology ; Epilepsy, Absence - therapy ; Female ; Follow-Up Studies ; Humans ; Male ; Prospective Studies ; Remission Induction ; Seizures - diagnosis ; Seizures - physiopathology ; Seizures - therapy ; Time Factors ; Treatment Outcome</subject><ispartof>Epilepsia (Copenhagen), 2014-04, Vol.55 (4), p.551-557</ispartof><rights>Wiley Periodicals, Inc. © 2014 International League Against Epilepsy</rights><rights>Wiley Periodicals, Inc. © 2014 International League Against Epilepsy.</rights><rights>Copyright © 2014 International League Against Epilepsy</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4761-8b263a2a7dfdc19456cf7f9304bd26bb8c2c81b2c5f7adb6e36d9b9fcb53a7d53</citedby><cites>FETCH-LOGICAL-c4761-8b263a2a7dfdc19456cf7f9304bd26bb8c2c81b2c5f7adb6e36d9b9fcb53a7d53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fepi.12551$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fepi.12551$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,780,784,885,1417,1433,27924,27925,45574,45575,46409,46833</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24512528$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Berg, Anne T.</creatorcontrib><creatorcontrib>Levy, Susan R.</creatorcontrib><creatorcontrib>Testa, Francine M.</creatorcontrib><creatorcontrib>Blumenfeld, Hal</creatorcontrib><title>Long‐term seizure remission in childhood absence epilepsy: Might initial treatment matter?</title><title>Epilepsia (Copenhagen)</title><addtitle>Epilepsia</addtitle><description>Summary
Objective
Examine the possible association between long‐term seizure outcome in childhood absence epilepsy (CAE) and the initial treatment choice.
Methods
Children with CAE were prospectively recruited at initial diagnosis and followed in a community‐based cohort study. Children presenting with convulsive seizures, significant imaging abnormalities, or who were followed <5 years were excluded. Early outcomes included success of initial medication, early remission, and pharmacoresistance. The primary long‐term outcome was complete remission: ≥5 years both seizure free and medication free. Survival methods were used for analyses.
Results
The first medication was ethosuximde (ESM) in 41 (69%) and valproic acid (VPA) in 18 (31%). Initial success rates were 59% (ESM) and 56% (VPA). Early remission and pharmacoresistance were similar in each group. Apart from atypical electroencephalography (EEG) features (61% [VPA], 17% [ESM]), no clinical features varied substantially between the treatment groups. Complete remission occurred in 31 children (76%) treated with ESM and 7 (39%) who received VPA (p = 0.007). Children with versus without atypical EEG features were less likely to enter complete remission (50% vs. 71%, p = 0.03). In a Cox regression, ESM was associated with a higher rate of complete remission than VPA (hazards ratio [HR] 2.5, 95% confidence interval [CI] 1.1–6.0; p = 0.03). Atypical EEG features did not independently predict outcome (p = 0.15). Five‐year and 10‐year remission, regardless of continued treatment, occurred more often in children initially treated with ESM versus VPA.
Significance
These findings are congruent with results of studies in genetic absence models in rats and provide preliminary evidence motivating a hypothesis regarding potential disease‐modifying effects of ESM in CAE.
A PowerPoint slide summarizing this article is available for download in the Supporting Information section here.</description><subject>Absence seizures</subject><subject>Antiepileptic drugs</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Cohort Studies</subject><subject>Comparative effectiveness</subject><subject>Confidence intervals</subject><subject>Disease modification</subject><subject>Electroencephalography</subject><subject>Electroencephalography - trends</subject><subject>Epilepsy, Absence - diagnosis</subject><subject>Epilepsy, Absence - physiopathology</subject><subject>Epilepsy, Absence - therapy</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Male</subject><subject>Prospective Studies</subject><subject>Remission Induction</subject><subject>Seizures - diagnosis</subject><subject>Seizures - physiopathology</subject><subject>Seizures - therapy</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>0013-9580</issn><issn>1528-1167</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkU9rFDEchoMo7bb20C8gAS_2MG3-ThIPSilVCyt60JsQkkxmN2Vmsk1mLNtTP4Kf0U9itluLFQRzySFPnvzyvgAcYnSMyzrxq3CMCef4CZhhTmSFcS2eghlCmFaKS7QL9nK-RAiJWtAdsEsYLzyRM_BtHofFz9sfo089zD7cTMnD5PuQc4gDDAN0y9A1yxgbaGz2g_OwPNf5VV6_hh_DYjkWKIzBdHBM3oy9H0bYm7EI3z4Hz1rTZX9wv--Dr-_Ov5x9qOaf3l-cnc4rx0SNK2lJTQ0xomkbhxXjtWtFqyhitiG1tdIRJ7EljrfCNLb2tG6UVa2znJZLnO6DN1vvarK9b1wZIZlOr1LoTVrraIJ-fDKEpV7E75oqpbAkRfDqXpDi1eTzqEsAznedGXycsi6hMoYwY-w_UCwlpkJsrC__Qi_jlIaSxB2FlGByIzzaUi7FnJNvH-bGSG_q1SVvfVdvYV_8-dEH8nefBTjZAtelovW_Tfr888VW-QvfqrGM</recordid><startdate>201404</startdate><enddate>201404</enddate><creator>Berg, Anne T.</creator><creator>Levy, Susan R.</creator><creator>Testa, Francine M.</creator><creator>Blumenfeld, Hal</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TK</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>201404</creationdate><title>Long‐term seizure remission in childhood absence epilepsy: Might initial treatment matter?</title><author>Berg, Anne T. ; Levy, Susan R. ; Testa, Francine M. ; Blumenfeld, Hal</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4761-8b263a2a7dfdc19456cf7f9304bd26bb8c2c81b2c5f7adb6e36d9b9fcb53a7d53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Absence seizures</topic><topic>Antiepileptic drugs</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Cohort Studies</topic><topic>Comparative effectiveness</topic><topic>Confidence intervals</topic><topic>Disease modification</topic><topic>Electroencephalography</topic><topic>Electroencephalography - trends</topic><topic>Epilepsy, Absence - diagnosis</topic><topic>Epilepsy, Absence - physiopathology</topic><topic>Epilepsy, Absence - therapy</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Male</topic><topic>Prospective Studies</topic><topic>Remission Induction</topic><topic>Seizures - diagnosis</topic><topic>Seizures - physiopathology</topic><topic>Seizures - therapy</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Berg, Anne T.</creatorcontrib><creatorcontrib>Levy, Susan R.</creatorcontrib><creatorcontrib>Testa, Francine M.</creatorcontrib><creatorcontrib>Blumenfeld, Hal</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Epilepsia (Copenhagen)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Berg, Anne T.</au><au>Levy, Susan R.</au><au>Testa, Francine M.</au><au>Blumenfeld, Hal</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Long‐term seizure remission in childhood absence epilepsy: Might initial treatment matter?</atitle><jtitle>Epilepsia (Copenhagen)</jtitle><addtitle>Epilepsia</addtitle><date>2014-04</date><risdate>2014</risdate><volume>55</volume><issue>4</issue><spage>551</spage><epage>557</epage><pages>551-557</pages><issn>0013-9580</issn><eissn>1528-1167</eissn><coden>EPILAK</coden><abstract>Summary
Objective
Examine the possible association between long‐term seizure outcome in childhood absence epilepsy (CAE) and the initial treatment choice.
Methods
Children with CAE were prospectively recruited at initial diagnosis and followed in a community‐based cohort study. Children presenting with convulsive seizures, significant imaging abnormalities, or who were followed <5 years were excluded. Early outcomes included success of initial medication, early remission, and pharmacoresistance. The primary long‐term outcome was complete remission: ≥5 years both seizure free and medication free. Survival methods were used for analyses.
Results
The first medication was ethosuximde (ESM) in 41 (69%) and valproic acid (VPA) in 18 (31%). Initial success rates were 59% (ESM) and 56% (VPA). Early remission and pharmacoresistance were similar in each group. Apart from atypical electroencephalography (EEG) features (61% [VPA], 17% [ESM]), no clinical features varied substantially between the treatment groups. Complete remission occurred in 31 children (76%) treated with ESM and 7 (39%) who received VPA (p = 0.007). Children with versus without atypical EEG features were less likely to enter complete remission (50% vs. 71%, p = 0.03). In a Cox regression, ESM was associated with a higher rate of complete remission than VPA (hazards ratio [HR] 2.5, 95% confidence interval [CI] 1.1–6.0; p = 0.03). Atypical EEG features did not independently predict outcome (p = 0.15). Five‐year and 10‐year remission, regardless of continued treatment, occurred more often in children initially treated with ESM versus VPA.
Significance
These findings are congruent with results of studies in genetic absence models in rats and provide preliminary evidence motivating a hypothesis regarding potential disease‐modifying effects of ESM in CAE.
A PowerPoint slide summarizing this article is available for download in the Supporting Information section here.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>24512528</pmid><doi>10.1111/epi.12551</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Wiley Online Library Free Content; Access via Wiley Online Library; IngentaConnect Free/Open Access Journals; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Absence seizures Antiepileptic drugs Child Child, Preschool Cohort Studies Comparative effectiveness Confidence intervals Disease modification Electroencephalography Electroencephalography - trends Epilepsy, Absence - diagnosis Epilepsy, Absence - physiopathology Epilepsy, Absence - therapy Female Follow-Up Studies Humans Male Prospective Studies Remission Induction Seizures - diagnosis Seizures - physiopathology Seizures - therapy Time Factors Treatment Outcome |
| title | Long‐term seizure remission in childhood absence epilepsy: Might initial treatment matter? |
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