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KMID : 0350519920450041349
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Journal of Catholic Medical College
1992 Volume.45 No. 4 p.1349 ~ p.1363
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A Study on Hypothetical Factors Predicting the Response to Antiepileptic Drug in the Early Phase of Treatment of Epileptic Children
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Abstract
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This study was designed to assess the hypothetical factors which predict the response to antiepileptic drug(AED) in the early phase of treatment of epileptic children.
This study included 457 patients(male 250, female 207) whose seizures were followed up for at least one year and studied thouroughly by neurological examination, brain CT and EEG, among 1,052 epileptic children 15 years of age seen at the child
neurology clinic of Kangnam St. Mary's Hospital. From 1981 to 1990.
The mean duration of follow-up investigation was 3. 6years.
The hypothetical factors examined in the study were sex, birth order, past history of febrile convulsion, age at the onset of seizures, frequency of seizures, duration of seizures, types of epilepsy, eiology, EEG, brain CT, and intellectual
develpment.
In order to evaluate the response to treatment, the patients were divided into arbitrarily three groups according to the following criteria: Group A(good response) included the patients who were seizure-free or occasional seizure only, Group
B(moderate
response) were those with moderate reduction in seizure frequency, and Group C(poor response) were the patients with only light or no reduction in their seizure frequency to the therapy.
For testing the association between hypothetical factors and the responses to AED treatment, logistic regression analyses were applied, and for judging the degree of association between them, adjusted odds ratios were calculated.
@ES The results were as follows:
@EN 1. The overall incidences of good, moderate, and poor response to AED treatment were 64.8%, 12.9%, and 22.3%, respectively, of 457 epileptic chidren.
2. In the age at the onset of seizures, the relative risk of poor response to AED treatment in the patients whose seizures began before 2 years of age was 1.21 fold greater than those whose seizures began after 2 years of age in children with
partial
and generalized tonic-clonic seizures(P<0.004).
3. With regard to the prior frequency of seizures before a hospital visit in children with partial and generalized tonic-clonic seizures, the relative risk of poor response to AED treatment in patients with a history of more than 30 seizures was
4.76
fold greater, as compared with those with less than 30 seizures(P<0.000).
4. In the different types of epilepsy, the relative risk of poor response to AED treatment was high in the patients with mixed and complex partial seizures, and it was 10.5, and 2.86 fold greater,
5. With regard to the CT scan the relative risk of poor response to AED treatment in patients with abnormal CT finding was 3.68 fold greater than those with normal one(P<0.002).
6. With regard to the intellectual development, the relative risk of poor response to AED treatment in patients with low intelligence was 2.89 fold greater, as compared with those without mental retardation(P<0.000).
7. When two hypothetical factors, early age of the onset of seizures and prior frequent seizures, were superimposed in children with partial and generalized tonic-clonic seizures, the relative risk was 6.05 fold greater, and when the patients
with
mental retardation had etiology, long duration of seizures, early age of the onset of seizures, abnormal CT, and more than 30 seizures, the risks were 3.45, 4.03, 4.74, 13.66, 17.76 fold greater, respectively, and the values were statistically
significant.
8. However, the association between the response to AED treatment and hypothetical factors(sex, birth order, past history of febrile convulsion, duration of seizures, etiology or EEG finding) was found to be statistically insignificant.
It could be concluded that clinical factors predicting the response to AED treatment in the early phase of treatment in epileptic children were early onset of seizures, frequent prior seizures, specific seizure types, positive CT lesion, and low
intellectual development.
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KEYWORD
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