Abstracts

Rationale: Epilepsy in children is a major health problem and community based studies demonstrates an incidence that is between 20 and 190 cases/100000 inhabitant. This incidence is higher in developing countries were symptomatic epilepsies are the main diagnosis. After a first unprovoked seizure in children the recurrence risk is about 40 to 50%, with a elevated incidence of difficult to control cases. Predictors of major recurrence risks are electrographic abnormalities and symptomatic etiology. Children that start to have seizures before one year of age has the worst cognitive and developmental long term prognosis and the overall mortality associated with epilepsy is two to three times of the general population. Methods: 425 children evaluated at epilepsy outpatient clinic in 2002 were followed-up to 2008 in Ribeirão Preto Clinical Hospital. Patients were analyzed in respect of sex, age of epilepsy onset, epileptic syndrome according to ILAE, image findings, seizure control and outcome Results: 50.6% of children were females. From the 425 patients evaluated, 98.4% had epilepsy and only seven received other diagnosis. The main epilepsy diagnoses were focal symptomatic epilepsy (53.5%), generalized symptomatic epilepsy (32.6%), focal idiopathic epilepsy (4.7%), generalized idiopathic epilepsy (3.3%). Only 1.2% of children could not be classified. Image resonance or topographic scans were realized in 93.2% of the patients, and were normal in 29% of the cases. Main abnormalities were destructive lesions, malformations of cortical development, tuberous sclerosis, Sturge-Weber Syndrome and brain tumors. At the end of follow-up 50.9% of patients persisted with seizures, 45.8% were seizure free for at least one year and 3.3% of cases were lost. 55 patients (13.9%) were operated on. Twenty patients or 5% died in the period. From this group of patients, 17 still had seizures and three were controlled (p=0.0026), 16 patients died of clinical complications as infections or status epilepticus; one patient died due to epilepsy surgery complications. In three patients death cause could not be identified and may be considered as sudden unexpected death (SUDEP) related to epilepsy. Conclusions: Camfield and Camfield (2008) demonstrated a long term remission of community based epilepsy of approximately 60% and intractable epilepsy of 7 to 8%. Mortality rates in developed countries range from 1.6 to 3%. Our data shows an experience of a reference hospital and in this selected group a lower remission rate is expected with a higher incidence of refractory cases, since less severe epilepsies were not ascertained at our hospital and a higher mortality rate. In our series, death was significantly related to uncontrolled seizures and SUDEP was suspected in three patients