EEG and clinical predictors of medically intractable childhood epilepsy

Objectives: To identify electroencephalographic and clinical factors associ ated with both seizure control and medical intractability in children with epilepsy. Methods: We retrospectively reviewed EEGs and medical records from children with well-controlled epilepsy or medically intractable epilepsy. Subjects: Features of the initial EEG and clinical findings were compared i n 39 children with well controlled seizures and 144 with intractable epilep sy using both univariate and multivariate analyses. Results: Strong univariate associates were noted between intractability and several EEG factors: abnormal EEG background including diffuse slowing, as ymmetry, abnormal amplitude, a high frequency of spikes or sharp waves, and focal spike and wave activity. With multiple logistic regression, independ ent predictors of intractability were diffuse slowing and focal spike and w ave activity. Strong univariate associates of clinical factors with intract ability included: an early age of onset, simple partial, tonic, and myoclon ic seizures, a history of status epilepticus, a symptomatic etiology of the seizures, and abnormal magnetic resonance imaging of the head. Multivariat e analysis detected 4 independent clinical features associated with intract able epilepsy: symptomatic etiology, tonic seizures, simple partial seizure s, and an early age of onset. Conclusions: There are a number of EEG and clinical features that can be id entified early in the course of childhood epilepsy that are predictive of o utcome. These findings will need to be verified in a prospective study. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.