Prevalence, classification, and severity of epilepsy in children in Western Norway

Purpose: To determine prevalence of active epilepsy in school children in a defined area and assess the usefulness of International League Against Epi lepsy classification of seizures and epileptic syndromes, with special emph asis on frequency, additional handicaps, and therapeutic problems of severe cases. Methods: The latest International League Against Epilepsy International Cla ssification of Epileptic Seizures (ICES, 1981) and Epilepsies and Epileptic Syndromes (ICE, 1989) were used for determination of prevalence rates, sei zure types, epilepsies and epileptic syndromes, and additional neurological deficits in all 6- to 12-year-old children with epilepsy in a Norwegian co unty. Children had neuropediatric and EEG examination, intelligence evaluat ion, and, when necessary, additional investigations. Results: Prevalence of active epilepsy on January 1, 1995, was 5.1 per 1,00 0. Main seizure type and epilepsy syndrome could be classified in 98% and 9 0% of patients, respectively. Seizure types/epileptic syndromes were more o ften partial/localization related than generalized. Among generalized epile psies, idiopathic forms were more frequent in girls, and cryptogenic and sy mptomatic forms more frequent in boys. Epileptogenic EEG activity was most often generalized or localized to one or two areas of the brain and was nev er found in 14% of patients. Symptomatic etiology was found in 46% of all c hildren and in 81% of therapy-resistant cases, respectively. Over the years , 11% of children had never used antiepileptic drugs (AED), 62% had tried o ne or two AEDs, and 26% had tried from three to 15 AEDs. Twenty-five percen t of children were without present AED treatment. Complementary/alternative medicine had been tried by 12% of children. Conclusions: Although most epilepsies could be classified, the number of ca ses in nan-specific categories was relatively high. Symptomatic etiology wa s frequent, especially in therapy-resistant cases. Multidisciplinary therap eutic and habilitation approaches are often needed in childhood epilepsy.