ObjectiveTo investigate the clinical feature, prognosis and prognostic factors of early post-traumatic seizures in children. MethodsRetrospective review was performed on 101 individuals with early post-traumatic seizures (EPTS) who were diagnosed in Department of Neurosurgery in Children's Hospital of Chongqing Medical University from January 2008 to June 2013. The record was collected, which included patient's demographics, clinical and radiological presentation, management, and follow-up results of 12 months. The individuals were divided into late post-traumatic seizures (LPTS) group and control group according to the occurrence of LPTS or not. The SAS 9.2 was used for statistical analysis. ResultsDuring 101 cases in our study, male accounted for 60.4%, female accounted for 39.6%, and the ratio was 1.5 to 1. The percentage of patients who were under 6 years old was 74.3%, and the number of cases decreased with age. The peak time of EPTS was within 24 hours after traumatic brain injury. 55.4% of EPTS was the generalized seizures, 34.7% was the partial seizures, and 9.9% was the partial seizures and evolved to secondarily generalized seizures. The incidence of LPTS observed in our study was 26.7% within 12 months follow-up. The electroencephalogram displayed epileptiform discharges in 3 individuals who were without epileptic seizures. There was statistically significant difference in group LPTS compared to control group on these factors which included GSC score≤8(P=0.0064), complicated necrencephalus and/or encephalatrophy(P < 0.0001), multiple brain injuries(P=0.0210), subdural hemorrhage(P=0.0151) and intracranial operation(P=0.0029). The age, history, epileptic seizure type of EPTS, brain contusion, skull fracture and the early use of antiepileptic drugs (AEDs) had no statistically significant difference between LPTS group and control group(P > 0.05). ConclusionsEPTS is prone to occur in children under 6 years old. Male is obviously more than female, and the ratio is 1.5:1. The peak time of EPTS is within 24 hours after traumatic brain injury and most of EPTS are generalized seizures. The incidence of LPTS in children with EPTS exceeds those previously reported. Periodical electroencephalogram examination is essential to decrease the missed diagnosis of LPTS. The GSC score≤8 and complicated necrencephalus and/or encephalatrophy will dramaticlly increase the risk of LPTS. Multiple brain injuries, subdural hemorrhage and intracranial operation are also risk factors for the prognosis of EPTS. Although the use of AEDs is unable to decrease the incidence of LPTS after 12 months follow-up, it is probably beneficial to improving the cognition and brain development. The controversial finding in our study is whether intracranial operation can influence the prognosis of EPTS or not.
ObjectiveTo compare the efficacy and compliance of children children with refractory epilepsy receiving ketogenic diet (KD) in outpatient department with children receiving KD treatment in inpatient department. MethodsA retrospective study of 44 children with intractable epilepsy receiving the modified classical ketogenic diets in outpatient department from June 2014 to December 2015, who were followed-up during the third, sixth and twelfth month. Records of epileptic seizures and adverse reactions were used to evaluate the efficacy and retention rate of inpatient department KD treatment in children with refractory epilepsy, and compared with 104 children receiving KD treatment in inpatient department at the same period. ResultsThirty-four of the forty-four children comleted observation after 12-month follow-up, 15 cases had been seizure freedom, 22 cases had more than 50% reduction in seizure frequency, 12 patients had less than 50% reduction in seizure frequency.The total effective rate of the KD therapy in outpatient department was 64.7%, and the retention rate was 71%. 18 of of the 104 children with KD treatment in inpatient department at the same period comleted observation after 12-month follow-up, 3 cases had been seizure freedom, 5 cases had more than 50% reduction in seizure frequency, 13 cases had less than 50% reduction in seizure frequency.The total effective rate of the KD therapy in inpatient department was 27.8%, and the retention rate was 17.3%. ConclusionThe KD therapy in outpatient department is effective to children with intractable epilepsy, and there is a highly efficacy and compliance of children receiving KD in outpatient department comparing with children receiving KD in inpatient department. Therefore, it's optional to children with refractory epilepsy who can't received KD by inpatient department because of insufficient number of beds.
ObjectiveTo investigate the long-term retention rate of Oxcabazepine (OXC) in Chinese young children with symptomatic epilepsy and to evaluate the withdrawal causes of OXC. MethodsClinical features of 89 cases (male/female:48/41) from January.2009 to June.2015 were collected. Patients with symptomatic epilepsy who received mono-or adjunctive therapy with OXC. The initial dose was 10mg/kg/d twice a daily, 3~4weeks to increased to the target dose. OXC doses ranged between 12~53 mg/(kg·d) (mean dose:34.0±8.59 mg/(kg·d). An investigator recorded the antiepileptic drugs, seizure frequency, electroencephalogram and side effects for 3, 6, 12, 24 and 36months during follow-up. ResultsA total of 89 patients were enrolled in this investigation. patients with 50% reduction in seizure frequency in 6, 12, 24 and 36 months were 56.5%, 55.3%, 44.7%, 24.7%, and with seizure-free were 36.5%, 34.1%, 29.4%, 16.5%. In this research, 16(18.0%) patients experienced at least one side effect. The most common side effects observed were drowsiness 8 (42.1%), rash 3 (15.8%), and most were mild in severity. The retention rate of OXC in 3, 6, 12, 24, and 36months were 95.5%, 87.6%, 75.3%, 56.2%, 25.8%, respectively. The predominant causes of withdrawal were lack of efficacy 36(54.5%), end point 10(15.2%), adverse effects 8(12.1%), seizure-free 5(7.6%), follow-up loss 3(4.5%). COX analysis reveals that the age of onset was associated with treatment failure. ConclusionOur study demonstrates that OXC is safe and well tolerated in infants and very young children with symptomatic epilepsy, but the long-term retention rate is low. Whereas, for the purpose of better retention rate and therapeutic benefits, we should treat discretely depending on the complicated etiology and clinical features.