Role of early detection of predictors of poor seizure outcomes change the course of neurodevelopment
Shayla Imam Kanta1, Rizwanul Ahasan2, Humaira Rafiqa Quaderi3, Naila Zaman Khan4
Background: Epilepsy is the most common neurological disorder in children. In a
previous study in Bangladesh Banu et al (2003) showed three factors, i.e., multiple
seizure types, cognitive deficits and abnormal EEGs, to be predictors of poor seizure
remission, with a view of developing an appropriate system of management in a resource
constrained country like Bangladesh. Another study by Banu et al (2010) included
motor disability as another clinical predictor. Both these studies provide important
indicators for multidisciplinary services as part of epilepsy management programme.
Objectives: To determine if early identification of known predictors of poor seizure
outcome influences the course of the seizures and of neurodevelopemental outcomes.
Methods: A retrospective study of children attending the Child Development Center,
ie, a multidisciplinary service, in Dhaka Shishu Hospital. All children >2 years of
age at first attendance to the Epilepsy Clinic between 2010-2012 with follow-up records
including EEGs, were included. Patients were categorized in 2 groups, without poor
predictors & with poor predictors. Initial seizure semi logy, age, sex, family history,
EEG findings, neurodevelopemental profiles were observed and neurodevelopment
assessment after stimulation and treatment were compared with initial finding.
Results: Total 45 patients were taken according to inclusion & exclusion criteria
among them 9 patients were without poor predictors and 36 patients were with poor
predictors. Among the patients female were 40% & male were 60%. 82% patients had
idiopathic epilepsy and 12% patients had symptomatic epilepsy. Age below 12 months
was 15 & above 12 months was 30 family history of epilepsy was found in 6 patients,
Birth history was eventful in 21 patient and uneventful in 24 patients, seizure semiology
revealed patients age of onset, recurrence rate , immediate post ictal period had
significant association with patients with poor predictors. developmental domains in
patients with or without poor predictors categorized in normal, mild, moderate and
in severe form. In gross motor, fine motor, speech, behavior, and seizure shows
significant p value in patients with poor predictors which in subsequent follow up
showed much improvement in impairment grading .
Conclusion: So early identification of predictors of poor seizure outcome influence
the course of the seizures and neurodevelopemental outcomes which subsequently
improved due to early stimulation and therapy.
Key words: EEG, Epilepsy, Neurodevelopment, RNDA