Drug-resistant epilepsy in children under 14 years: clinical and epidemiological characteristics at a tertiary hospital in Lima, Peru
DOI:
https://doi.org/10.20453/rnp.v88i3.6314Keywords:
drug resistant epilepsy, antiepileptic drug, ketogenic diet, epilepsy/surgery, pediatricsAbstract
Objective: To determine the frequency and clinical characteristics of children with drug-resistant epilepsy treated at a national hospital in Lima, Peru. Materials and methods: A prospective, case-series study was conducted on patients under 14 years of age with drug-resistant epilepsy, treated between October 2013 and March 2014. Drug resistance was defined as the persistence of seizures despite the use of at least two antiepileptic drug regimens at maximum tolerated doses. Data were collected through interviews with family members and a review of medical records. Results: Forty-six patients were enrolled, representing 26.0 % of children under 14 years of age treated for epilepsy. The mean age was 8.46 ± 3.55 years, with 42.6 % of patients being female. The median age at seizure onset was 10.3 months, and the average duration of epilepsy was 6.5 years. Most patients (66 %) had symptomatic or cryptogenic epilepsy, with brain malformations and postnatal infections being the most common causes (14.9 % each). A total of 17 % of the patients were diagnosed with idiopathic epilepsy. The most common types of epilepsy were focal epilepsy not otherwise specified (42.6 %) and generalized epilepsy not otherwise specified (17 %), followed by Lennox-Gastaut syndrome (14.9 %). Regarding antiepileptic treatment, 51.1 % were receiving dual therapy and 21.3 % were on triple therapy. Additionally, 89.4 % had learning disorders and 85.1 % had intellectual disability. Among children over 3 years old, 37.5 % were not attending school. 19.1 % were hospitalized at least once in the past year, with an average hospitalization duration of 20.1 days. Conclusions: Drug-resistant epilepsy has a significant impact on the health and quality of life of children, creating a substantial burden on the healthcare system. Improving access to specialized treatments and comprehensive patient management is essential.
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References
Aicardi J. Epilepsy in brain-injured children. Dev Med Child Neurol [Internet]. 1990; 32(3): 191-202. Disponible en: https://doi.org/10.1111/j.1469-8749.1990.tb16925.x
Palencia-Luaces R. Prevalencia e incidencia de la epilepsia en la infancia. Rev Neurol [Internet]. 2000; 30(supl. 1): 1-4. Disponible en: https://doi.org/https://doi.org/10.33588/rn.30S1.2000129
Placencia M. Incidencia, prevalencia y magnitud global de las epilepsias en América Latina y El Caribe. En: Kanner AM, Campos MG, editores. Epilepsia: diagnóstico y tratamiento. Santiago de Chile: Mediterráneo; 2004. pp. 49-68.
Díaz D, Conde YA, Conde M, Navia IC, Conde BD. Epidemiología clínica de la epilepsia en niños y adolescentes del municipio Sancti Spíritus. Gac Méd Espirit [Internet]. 2013; 15(2). Disponible en: https://revgmespirituana.sld.cu/index.php/gme/article/view/311
Ko TS, Holmes GL. EEG and clinical predictors of medically intractable childhood epilepsy. Clin Neurophysiol [Internet]. 1999; 110(7): 1245-1251. Disponible en: https://doi.org/10.1016/s1388-2457(99)00068-1
Kwan P, Arzimanoglou A, Berg AT, Brodie MJ, Hauser WA, Mathern G, et al. Definition of drug resistant epilepsy: Consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia [Internet]. 2010; 51(6): 1069-1077. Disponible en: https://doi.org/10.1111/j.1528-1167.2009.02397.x
Berg AT, Levy SR, Novotny EJ, Shinnar S. Predictors of intractable epilepsy in childhood: A case-control study. Epilepsia [Internet]. 1996; 37(1): 24-30. Disponible en: https://doi.org/10.1111/j.1528-1157.1996.tb00507.x
Berg AT, Kaiser K, Dixon‐Salazar T, Elliot A, McNamara N, Meskis MA, et al. Seizure burden in severe early‐life epilepsy: perspectives from parents. Epilepsia Open [Internet]. 2019; 4(2): 293-301. Disponible en: https://doi.org/10.1002/epi4.12319
Auvin S, Specchio N. Pharmacotherapeutic strategies for drug-resistant epilepsy in children. Epilepsy Behav [Internet]. 2024; 161: 110139. Disponible en: https://doi.org/10.1016/j.yebeh.2024.110139
Maia Filho HS, Gomes MM. Análise crítica dos instrumentos de avaliação da qualidade de vida na epilepsia infantil. J Epilepsy Clin Neurophysiol. 2004; 10(3): 147-153.
Pohlmann‐Eden B, Weaver DF. The puzzle(s) of pharmacoresistant epilepsy. Epilepsia [Internet]. 2013; 54(s2): 1-4. Disponible en: https://doi.org/10.1111/epi.12174
Feely M. Drug treatment of epilepsy. BMJ [Internet]. 1999; 318: 106-109. Disponible en: https://doi.org/10.1136/bmj.318.7176.106
Hartman AL. Epilepsy in infants and children. En: Kellerman RD, Rakel DP, editores. Conn’s Current Therapy. Philadelphia: Elsevier; 2021. pp. 1263-1269.
Manreza ML, Marques-Dias MJ. Particularidades do tratamento. En: Manreza ML, Grossmann RM, Valério RM, Guilhoto LM, editores. Epilepsia na infância e na Adolescência. São Paulo: Lemos Editorial; 2003. pp. 447-459.
French JA, Kanner AM, Bautista J, Abou‐Khalil B, Browne T, Harden CL, et al. Efficacy and tolerability of the new antiepileptic drugs, II: treatment of refractory epilepsy: report of the TTA and QSS subcommittees of the American Academy of Neurology and the American Epilepsy Society. Epilepsia [Internet]. 2004; 45(5): 410-423. Disponible en: https://doi.org/10.1111/j.0013-9580.2004.06304.x
Martínez-Juárez IE, López-Zapata R, Gómez-Arias B, Bravo-Armenta E, Romero-Ocampo L, Estévez-Cruz Z, et al. Epilepsia farmacorresistente: uso de la nueva definición y factores de riesgo relacionados. Estudio en población mexicana de un centro de tercer nivel. Rev Neurol [Internet]. 2012; 54(3): 159-166. Disponible en: https://doi.org/10.33588/rn.5403.2011494
Janmohamed M, Brodie MJ, Kwan P. Pharmacoresistance – Epidemiology, mechanisms, and impact on epilepsy treatment. Neuropharmacology [Internet]. 2020; 168: 107790. Disponible en: https://doi.org/10.1016/j.neuropharm.2019.107790
Wiebe S. Definition of drug‐resistant epilepsy: Is it evidence based? Epilepsia [Internet]. 2013; 54(s2): 9-12. Disponible en: https://doi.org/10.1111/epi.12176
Mora LA, Hardaman C, Martinez O, Silva FA, Figuerola ML. Pharmacoresistant epilepsy. Observational retrospective study. Neurol Argent [Internet]. 2019; 11(3): 124-129. Disponible en: https://doi.org/10.1016/j.neuarg.2019.04.002
Brodie MJ. Road to refractory epilepsy: The Glasgow story. Epilepsia [Internet]. 2013; 54(s2): 5-8. Disponible en: https://doi.org/10.1111/epi.12175
Wirrell EC. Predicting pharmacoresistance in pediatric epilepsy. Epilepsia [Internet]. 2013; 54(s2): 19-22. Disponible en: https://doi.org/10.1111/epi.12179
Livingston JH. Management of intractable epilepsy. Arch Dis Child [Internet]. 1991; 66(12): 1454-1456. Disponible en: https://doi.org/10.1136/adc.66.12.1454
Alvarenga KG, Garcia GC, Ulhôa AC, Oliveira AJ, Mendes MF, Cesarini IM, et al. Epilepsia refratária: a experiência do Núcleo Avançado de Tratamento das Epilepsias do Hospital Felício Rocho (NATE) no período de março de 2003 a dezembro de 2006. J Epilepsy Clin Neurophysiol [Internet]. 2007; 13(2): 71-74. Disponible en: https://doi.org/10.1590/S1676-26492007000200006
Kumar G. Evaluation and management of drug resistant epilepsy in children. Curr Probl Pediatr Adolesc Health Care [Internet]. 2021; 51(7): 101035. Disponible en: https://doi.org/10.1016/j.cppeds.2021.101035
Mesraoua B, Brigo F, Lattanzi S, Abou-Khalil B, Al Hail H, Asadi-Pooya AA. Drug-resistant epilepsy: definition, pathophysiology, and management. J Neurol Sci [Internet]. 2023; 452: 120766. Disponible en: https://doi.org/10.1016/j.jns.2023.120766
Weaver DF, Pohlmann‐Eden B. Pharmacoresistant epilepsy: unmet needs in solving the puzzle(s). Epilepsia [Internet]. 2013; 54(s2): 80-85. Disponible en: https://doi.org/10.1111/epi.12191
Wolf P. Determinants of outcome in childhood epilepsy. Acta Neurol Scand Suppl [Internet]. 2005; 112(s182): 5-8. Disponible en: https://doi.org/10.1111/j.1600-0404.2005.00520.x
Choi H, Detyniecki K, Bazil C, Thornton S, Crosta P, Tolba H, et al. Development and validation of a predictive model of drug-resistant genetic generalized epilepsy. Neurology [Internet]. 2020; 95(15): e2150-2160. Disponible en: https://doi.org/10.1212/WNL.0000000000010597
Ream MA, Patel AD. Obtaining genetic testing in pediatric epilepsy. Epilepsia [Internet]. 2015; 56(10): 1505-1514. Disponible en: https://doi.org/10.1111/epi.13122
Morikawa T. Therapy-resistant epilepsy in children: with the view of the long-term outcome. Psychiatry Clin Neurosci [Internet]. 2004; 58(3): S7-S8. Disponible en: https://doi.org/10.1111/j.1440-1819.2004.01244_2.x
Liu S, An N, Yang H, Yang M, Hou Z, Liu L, et al. Pediatric intractable epilepsy syndromes: reason for early surgical intervention. Brain Dev [Internet]. 2007; 29(2): 69-78. Disponible en: https://doi.org/10.1016/j.braindev.2006.06.009
Boel MJ. Behavioural and neuropsychological problems in refractory paediatric epilepsies. Eur J Paediatr Neurol [Internet]. 2004; 8(6): 291-297. Disponible en: https://doi.org/10.1016/j.ejpn.2004.08.002
Donner EJ. Opportunity gained, opportunity lost: treating pharmacoresistant epilepsy in children. Epilepsia [Internet]. 2013; 54(s2): 16-18. Disponible en: https://doi.org/10.1111/epi.12178
Élices-Palomar E, Arroyo S. ¿Es progresiva la epilepsia parcial farmacorresistente? Rev Neurol [Internet]. 2002; 34(6): 505-510. Disponible en: https://doi.org/10.33588/rn.3406.2001360
Laxer KD, Trinka E, Hirsch LJ, Cendes F, Langfitt J, Delanty N, et al. The consequences of refractory epilepsy and its treatment. Epilepsy Behav [Internet]. 2014; 37: 59-70. Disponible en: https://doi.org/10.1016/j.yebeh.2014.05.031
Fusco L, Vigevano F. Indications for surgical treatment of epilepsy in childhood: a clinical and neurophysiological approach. Acta Paediatr [Internet]. 2004; 93(s445): 28-31. Disponible en: https://doi.org/10.1111/j.1651-2227.2004.tb03052.x
Lim ME, Bowen JM, Snead OC, Elliott I, Donner E, Weiss SK, et al. Access to surgery for paediatric patients with medically refractory epilepsy: a systems analysis. Epilepsy Res [Internet]. 2013; 107(3): 286-296. Disponible en: https://doi.org/10.1016/j.eplepsyres.2013.08.010
Mecarelli O, Di Gennaro G, Vigevano F. Unmet needs and perspectives in management of drug resistant focal epilepsy: an Italian study. Epilepsy Behav [Internet]. 2022; 137: 108950. Disponible en: https://doi.org/10.1016/j.yebeh.2022.108950
Sharp GB, Samanta D, Willis E. Options for pharmacoresistant epilepsy in children: when medications don’t work. Pediatr Ann [Internet]. 2015; 44(2): e43-e48. Disponible en: https://doi.org/10.3928/00904481-20150203-11
Pérez P. Costo médico directo de la epilepsia en la población hospitalaria del Hospital III Miguel Grau de EsSalud. Acta Méd Peru [Internet]. 2010; 27(1): 37-42. Disponible en: http://www.scielo.org.pe/pdf/amp/v27n1/a07v27n1.pdf
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