Pretreatment seizure semiology in childhood absence epilepsy
| Autor: | Shlomo Shinnar, Sudha Kilaru Kessler, Dennis J. Dlugos, Eli M. Mizrahi, Peggy Clark, Solomon L. Moshé, Joan Conry, Tracy A. Glauser, F. Hu, Avital Cnaan, Chunyan Liu, Deborah Hirtz |
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| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Adolescent Eye Movements Electroencephalography Audiology Article law.invention 03 medical and health sciences Epilepsy 0302 clinical medicine Childhood absence epilepsy Randomized controlled trial Double-Blind Method law Seizures Outcome Assessment Health Care medicine Humans 030212 general & internal medicine Seizure semiology Child medicine.diagnostic_test business.industry Eye movement Semiology medicine.disease Absence seizure Epilepsy Absence Child Preschool Anticonvulsants Female Neurology (clinical) business 030217 neurology & neurosurgery Follow-Up Studies |
| Popis: | Objective:To determine seizure semiology in children with newly diagnosed childhood absence epilepsy and to evaluate associations with short-term treatment outcomes.Methods:For participants enrolled in a multicenter, randomized, double-blind, comparative-effectiveness trial, semiologic features of pretreatment seizures were analyzed as predictors of treatment outcome at the week 16 to 20 visit.Results:Video of 1,932 electrographic absence seizures from 416 participants was evaluated. Median seizure duration was 10.2 seconds; median time between electrographic seizure onset and clinical manifestation onset was 1.5 seconds. For individual seizures and by participant, the most common semiology features were pause/stare (seizure 95.5%, participant 99.3%), motor automatisms (60.6%, 86.1%), and eye involvement (54.9%, 76.5%). The interrater agreement for motor automatisms and eye involvement was good (72%–84%). Variability of semiology features between seizures even within participants was high. Clustering analyses revealed 4 patterns (involving the presence/absence of eye involvement and motor automatisms superimposed on the nearly ubiquitous pause/stare). Most participants experienced more than one seizure cluster pattern. No individual semiologic feature was individually predictive of short-term outcome. Seizure freedom was half as likely in participants with one or more seizure having the pattern of eye involvement without motor automatisms than in participants without this pattern.Conclusions:Almost all absence seizures are characterized by a pause in activity or staring, but rarely is this the only feature. Semiologic features tend to cluster, resulting in identifiable absence seizure subtypes with significant intraparticipant seizure phenomenologic heterogeneity. One seizure subtype, pause/stare and eye involvement but no motor automatisms, is specifically associated with a worse treatment outcome. |
| Databáze: | OpenAIRE |
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