Evaluation of compliance to outpatient follow-up and factors affecting epilepsy prognosis in children
Aim and Background: Epilepsy is an important chronic neurological disease in the pediatric population and the main goal of treatment is to prevent recurrent seizures. Cognitive, neurological and behavioral status of the patient and the side effects of antiepileptic drug (AED) are monitored in follow-up visits. In this study, we investigated the clinical characteristics and the factors affecting prognosis in children with epilepsy and receiving antiepileptic drug therapy, their treatment compliance and outpatient follow-up.
Method: Records of patients who applied to the pediatric outpatient clinic and followed for 6 to 24 months for epilepsy were analyzed retrospectively over a period of 46 months. Patients who were regularly followed up for 24 months and adherent to AED were described as the compliant group. Sociodemographic factors and clinical data were evaluated by descriptive statistics and Chi-Square, Kruskal Wallis and Mann Whitney-U tests.
Results: A total of 87 patients who were included to the study, consisted of 36 girls(41.4%) and 51 boys(58.6%) and had a mean age of 67.7±38.6 months. The first seizure frequently occurred between 0-24 months of age (44.7%). Generalized syndromes were more frequent (59.8%). The 43.8 percent of patients applied to outpatient clinic in twenty-four hours after the first seizure. As the age of the onset of the first seizure increases, the period between onset of seizures and admittance to the outpatient clinic decreased(p<0.05; r = -0.33). All patients continued to attend the follow-up visits and were compliant with AEDs in the first 6 months in which relapses decreased. Patients who were adherent to the outpatient follow-up and antiepileptic drug therapy for 24 months were 45(52%) and their seizure frequency decreased (p<0.0001) and less abnormal EEGs were present. In our patient group, family history, history of febrile convulsion, type of epilepsy syndrome, age of onset, time to start treatment after the first seizure, type of AED did not affect the prognosis of epilepsy.
Discussion and Conclusion: In patients compliant to regular follow-up, relapses decreased and remission periods increased and EEGs which were previously pathological improved to a great extent in 24 months. Routine follow-up and compliance with treatment are important for successful management of epilepsy. Due to the inadequate awareness of families there are delays in referrals to outpatient clinics and nonadherence with follow-up care. For better prognosis children with epilepsy, a holistic approach is needed to be adopted in which primary care physicians participate.
- Chabolla DR. Characteristics of the epilepsies. Mayo Clin Proc 2002 Sep; 77(9):981-90.
- Jacob L, Hamer HM, Kostev K. Adherence to antiepileptic drugs in children and adolescents: A retrospective study in primary care settings in Germany. Epilepsy Behav 2017 Oct; 75: 36-41. doi: 10.1016/j.yebeh.2017.07.001.
- Camfield PR, Camfield CS. What happens to children with epilepsy when they become adults? Some facts and opinions. Pediatr Neurol 2014 Jul; 51(1):17-23. doi: 10.1016/j.pediatrneurol.2014.02.020.
- Commission on Classification and Terminology of the International League Against Epilepsy; Proposal for Classification of Epilepsy and Epileptic Syndromes. Epilepsia 1989, 30 (4); 389-99.
- Camfield P, Camfield C. When is it safe to discontinue AED treatment? Epilepsia 2008 Dec;49 Suppl 9:25-8. doi: 10.1111/j.1528-1167.2008.01923.x.
- Sillanpää M, Jalava M, Kaleva O, Shinnar S. Long-term prognosis of seizures with onset in childhood. N Engl J Med 1998 Jun 11;338(24):1715-22.
- Wakamoto H, Nagao H, Hayashi M, Morimoto T. Long-term medical, educational, and social prognoses of childhood-onset epilepsy: a population-based study in a rural district of Japan. Brain Dev 2000 Jun;22(4):246-55.
- Lee IC, Li SY, Chen YJ. Seizure Recurrence in Children after Stopping Antiepileptic Medication: 5-Year Follow-Up. Pediatr Neonatol 2017 Aug; 58(4): 338-43. doi: 10.1016/j.pedneo.2016.08.005.
- Gollwitzer S, Kostev K, Hagge M, Lang J, Graf W, and Hamer HM: Nonadherence to antiepileptic drugs in Germany: a retrospective, population-based study. Neurology 2016; 87: 466-72.
- Yang C, Hao Z, Yu D, Xu Q, Zhang L. The prevalence rates of medication adherence and factors influencing adherence to antiepileptic drugs in children with epilepsy: A systematic review and meta analysis. Epilepsy Res 2018 May; 142: 88-99. doi: 10.1016/j.eplepsyres.2018.03.018.
- Berg AT, Shinnar S. Relapse Following Discontinuation of Antiepileptic Drugs: A meta-analysis. Neurology 1994, (44); 601-8.
- Fisher RS, Acevedo C, Arzimanoglou A, Bogacz A, Cross JH, Elger CE, et al. ILAE official report: a practical clinical definition of epilepsy. Epilepsia 2014 Apr;55(4):475-82. doi: 10.1111/epi.12550.
- Scheffer IE, Berkovic S, Capovilla G, Connolly MB, French J, Guilhoto L, et al. ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology. Epilepsia 2017 Apr;58(4):512-21. doi: 10.1111/epi.13709.
- 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; 58:522–30.
- Sirven JI. Antiepileptic drug therapy for adults: when to initiate and how to choose. Mayo Clin Proc 2002 Dec;77(12):1367-75.
- Shinnar S, Berg AT, O’Dell C, Newstein D, Moshe SL, Hauser WA. Predictors of multiple seizures in a cohort of children prospectively followed from the time of their first unprovoked seizure. Ann Neurol 2000 Aug;48(2):140-7.
- Cockerell OC1, 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 Jan;38(1):31-46.
- Olmez A, Arslan U, Turanli G, Aysun S. Risk of recurrence after drug withdrawal in childhood epilepsy. Seizure 2009;18:251–6.
- Incecik F, Herguner OM, Altunbasak S, Mert G, Kiris N. Risk of recurrence after discontinuation of antiepileptic drug therapy in children with epilepsy. J Pediatr Neurosci 2014 May-Aug; 9(2): 100–104. doi: 10.4103/1817-1745.139262
- Modi AC, Rausch JR, Glauser TA. Patterns of nonadherence to antiepileptic drug therapy in children with newly diagnosed epilepsy. JAMA 2011 Apr; 305(16):1669-76. doi: 10.1001/jama.2011.506.
- Shetty J, Greene SA, Mesalles-Naranjo O, Kirkpatrick M. Adherence to antiepileptic drugs in children with epilepsy in a Scottish population cohort. Dev Med Child Neurol 2016 May; 58(5):469-74. doi: 10.1111/dmcn.12942.
- Alsous M, Hamdan I, Saleh M, McElnay J, Horne R, Masri A. Predictors of nonadherence in children and adolescents with epilepsy: A multimethod assessment approach. Epilepsy Behav 2018 Aug;85:205-211. doi: 10.1016/j.yebeh.2018.06.022.
- Paschal AM, Mitchell QP, Wilroy JD, Hawley SR, Mitchell JB. Parent health literacy and adherence-related outcomes in children with epilepsy. Epilepsy Behav 2016 Mar;56:73-82. doi: 10.1016/j.yebeh.2015.12.036.