Prognostic factors of refractory epilepsy in children

Background Epilepsy is one of the most common pediatric neurological disorders. Twenty percent of patients will develop refractory epilepsy. Early identification of refractory epilepsy will be helpful to conduct adequate counseling and selecting patients who need more intensive investigation and treatment. Objective To identify the clinical characteristics and other factors that are related to refractory epilepsy in children. Methods We conducted a case control study in patients of two to 18 years old with epilepsy that admitted to Dr. Sardjito Hospital. There were 4 7 children with refractory epilepsy compared with 122 subjects who have been one year free of seizure. Results Strong association had been noted between refractory and several clinical factors: early onset of seizure, high initial seizure frequency, neonatal asphyxia, symptomatic etiology, status epilepticus, abnormal neurodevelopmental status, and early breakthrough seizures after treatment initiation. On multivariate analysis, more than 20 seizures prior to treatment initiation (OR 3.40, 95% CI 1.03 to 11.3), and more than three seizures in the subsequent six month after treatment initiation (OR 16.02, 95% CI 4.98 to 51.5) were independent prognostic factors related to refractory epilepsy. Conclusion Children who present high frequency seizures at onset and more than 3 breakthrough seizures subsequent to six month after treatment have risks of developing refractory epilepsy