COMMENTARY

How Many Children With Epilepsy Become Drug Resistant?

William T. Basco, Jr., MD, MS

Disclosures

November 06, 2018

Antiepileptic Treatment Outcomes in Children

The goal of antiepileptic treatment is seizure freedom, but some children have drug-resistant epilepsy. To date, reliable data on the outcomes of antiepileptic therapy—how many children achieve seizure freedom, and how many don't—have not been available. The goal of a recent study[1] was to address this gap in our knowledge about the outcomes of antiepileptic therapy in children with seizures.

Using data from a 10-year birth cohort in Norway, the investigators assessed the proportion of children with epilepsy who became seizure-free, and the factors associated with this outcome. They also assessed the number of children with drug-resistant epilepsy, defined as failure to achieve seizure freedom for at least 1 year after appropriate trials of at least two antiepileptic drugs. The birth cohort included 112,745 children ranging in age from 3 to 13 years at the end of the study. From this cohort, the investigators identified 606 children with epilepsy, with a median age of onset of 3 years. Each child with epilepsy had been tried on a median of two antiepileptic drugs.

Overall, 59% of the children had been seizure-free for at least 1 year, but 30% had developed drug-resistant epilepsy. An adjusted analysis looked at the relative risk of developing drug-resistant epilepsy and concluded that gender, a family history of epilepsy, and a history of febrile seizure were not associated with the risk of developing drug-resistant epilepsy. Individually, these factors had previously been found to be associated with drug-resistant epilepsy.

However, having three or more seizure types was positively associated with developing drug-resistant epilepsy as was having an identified cause of epilepsy (genetic, structural, metabolic, or infectious). The authors concluded that in this population-based cohort study 59% of the children with epilepsy achieved at least 1 year of freedom from seizures, 30% had drug-resistant epilepsy, and 12% had an indeterminate course.

Viewpoint

If nothing else, the study offers some hope to practitioners and parents of newly diagnosed children with seizures that a majority can become seizure-free. Even some children with known risk factors for developing drug-resistant epilepsy became seizure-free, explaining why neurologists are so hesitant to offer predictions to parents! I'm sympathetic to their plight.

I'm more concerned about the generalizability of the findings of this study than I have been about other studies, for two reasons. One limitation is genetic variations in the causes of seizures across countries, and another is disparities in access to healthcare. Low-income children in the United States and other countries may not have the same access to healthcare as do low-income Norwegian children. Regardless, the overall pattern indicating that most children become seizure-free would likely be similar in other countries, even if the absolute numbers would undoubtedly be very different.

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