This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Camfield, P. Articles by Camfield, C. Search for Related Content PubMed PubMed Citation Articles by Camfield, P. Articles by Camfield, C. Social Bookmarking                   What's this?

Childhood Epilepsy: What Is the Evidence for What We Think and What We Do?

Department of Pediatrics, Dalhousie University and the IWK Health Centre, Halifax, NS, Camfield{at}dal.ca.

Carol Camfield, MD, FRCPC

Department of Pediatrics, Dalhousie University and the IWK Health Centre, Halifax, NS

This article reviews the strength of the evidence that underlies the current approach to the management of childhood epilepsy. The authors reviewed published, peer-reviewed English literature accessed through PubMed and Cochrane reviews with evidence rated as Class 1 (strongest) to Class 4 (weakest). There is considerable inaccuracy in the diagnosis of seizures and epilepsy syndromes. Sound information supports the consensus that the diagnosis of epilepsy should await two unprovoked seizures. Population-based studies indicate that remission from childhood onset epilepsy occurs in at least 50% of children. It is easier to predict a good seizure outcome than a poor one. Absence of concomitant neurologic handicap and onset before about 12 years of age are the most consistent predictors of remission. Intractability is poorly defined and difficult to predict until several antiepilepsy drugs have been used and failed to control the seizures. Most epilepsy syndrome diagnoses do not yield an accurate prognosis. Social outcome appears unsatisfactory in about 50% of cases without intellectual handicap. Death is rare in childhood epilepsy. Those without severe neurologic handicaps have the same mortality as the general population. We identified only 27 published randomized trials of antiepilepsy drugs in children that compare the efficacy of antiepilepsy drugs, offer treatment of syndromes currently without successful treatment, or have negative effects. There is a pressing need for better definitions of seizures and epilepsy syndromes. The causes of poor social outcome are unclear. Intractability needs a clear definition and randomized trials comparing treatment regimes are sadly lacking. (J Child Neurol 2003; 18:272-287).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				M. Oskoui, R. I. Webster, Xun Zhang, and M. I. Shevell Factors Predictive of Outcome in Childhood Epilepsy J Child Neurol, November 1, 2005; 20(11): 898 - 904. [Abstract] [PDF]

				I C K Wong, T Awolowo, K Gordon, and Y W Mo Survey of administration of medicines to pupils in primary schools within the London area Arch. Dis. Child., November 1, 2004; 89(11): 998 - 1001. [Abstract] [Full Text] [PDF]