Studio multicentrico osservazionale prospettico su epilessia non idiopatica focale

The aim of the study was to identify the early predictors of clinical and neuropsychological outcomes in non-idiopathic partial epilepsy in childhood. One hundred fifty-four consecutive patients (88 M, 66 F; mean age: 5 yrs and 3 m, range 1 m-12yrs) were prospectively enrolled at 14 Italian Centers specialized in childhood epilepsy. Results: there was a positive family history of epilepsy and/or febrile seizures in 24.2%; status epilepticus at onset in 11%. At baseline seizure semiology was 34% frontal; 37% temporal; 29% posterior. EEG at enrollment: focal 50.7%; multilobar 20.8%; multifocal 22.7%; diffuse 0.6%; normal 5.2%. At the first presentation MRI was negative in 59/150 patients (39.1%); in 60.9% (93/150) MRI revealed abnormalities: neoplasm 8.7%, focal cortical dysplasias 29.3%; vascular disease 21.7%; scar results 8.7%, nonspecific abnormalities (hydrocephalus, periventricular leukomalacia, hypoxic-ischemic outcomes) in 31.5%. Most patients (65.6%, 101/154) were in monotherapy; the drug most commonly used was CBZ; in 15.0% (23/154) polytherapy was required for seizures control; conversely 30 patients did not need treatment at baseline: 30.5% had an abnormal neurological examination; 43.7% (55/132) had cognitive function impaired and 19.8% (17/86) presented an altered psychopathological profile. At the 6-month follow-up, seizures recurred in 39.8% of patients and the predictors of recurrence were abnormalities on cerebral MRI, neurological examination and cognitive profile. More data, at longer follow-up, are needed to delineate the predictors of intractability in childhood.