Symptomatic and presumed symptomatic focal epilepsies in childhood: An observational, prospective multicentre study.
OBJECTIVE
To describe the clinical, neuropsychological, and psychopathologic features of a cohort of children with a new diagnosis of symptomatic or presumed symptomatic focal epilepsy at time of recruitment and through the first month. The selected population will be followed for 2-5 years after enrollment to investigate the epilepsy course and identify early predictors of drug resistance.


METHODS
In this observational, multicenter, nationwide study, children (age 1 month-12.9 years) with a new diagnosis of symptomatic or presumed symptomatic focal epilepsy were consecutively enrolled in 15 Italian tertiary childhood epilepsy centers. Inclusion criteria were as follows: (1) diagnosis of symptomatic focal epilepsy due to acquired and developmental etiologies, and presumed symptomatic focal epilepsy; (2) age at diagnosis older than 1 month and <13 years; and (3) written informed consent. Children were subdivided into three groups: ≤3 years, >3 to 6 years, and >6 years. Clinical, electroencephalography (EEG), neuroimaging, and neuropsychological variables were identified for statistical analyses.


RESULTS
Two hundred fifty-nine children were enrolled (116 female and 143 male). Median age: 4.4 years (range 1 month-12.9 years); 46.0% (n = 119) of children were younger than 3 years, 24% (61) from 3 to 6 years of age, and 30% (79) older than 6 years. Neurologic examination findings were normal in 71.8%. Brain magnetic resonance imaging (MRI) was abnormal in 59.9%. Children age ≤3 years experienced the highest seizure frequency in the first month after recruitment (p < 0.0001). Monotherapy in the first month was used in 67.2%. Cognitive tests at baseline revealed abnormal scores in 30%; behavioral problems were present in 21%. At multivariate analysis, higher chances to exhibit more than five seizures in the first month after epilepsy onset was confirmed for younger children and those with temporal lobe epilepsy.


SIGNIFICANCE
In this prospective cohort study, an extensive characterization of epilepsy onset in children with symptomatic or presumed symptomatic focal epilepsies is reported in relation to the age group and the localization of the epileptogenic zone.
['Vecchi|Marilena|M|', 'Barba|Carmen|C|0000-0001-5445-5842', 'De Carlo|Debora|D|', 'Stivala|Micol|M|', 'Guerrini|Renzo|R|', 'Albamonte|Emilio|E|', 'Ranalli|Domiziana|D|', 'Battaglia|Domenica|D|', 'Lunardi|Giada|G|', 'Boniver|Clementina|C|', 'Piccolo|Benedetta|B|', 'Pisani|Francesco|F|', 'Cantalupo|Gaetano|G|', 'Nieddu|Giuliana|G|', 'Casellato|Susanna|S|', 'Cappanera|Silvia|S|', 'Cesaroni|Elisabetta|E|', 'Zamponi|Nelia|N|', 'Serino|Domenico|D|', 'Fusco|Lucia|L|', 'Iodice|Alessandro|A|', 'Palestra|Filippo|F|', 'Giordano|Lucio|L|', 'Freri|Elena|E|', 'De Giorgi|Ilaria|I|', 'Ragona|Francesca|F|', 'Granata|Tiziana|T|', 'Fiocchi|Isabella|I|', 'Bova|Stefania Maria|SM|', 'Mastrangelo|Massimo|M|', 'Verrotti|Alberto|A|', 'Matricardi|Sara|S|', 'Fontana|Elena|E|', 'Caputo|Davide|D|', 'Darra|Francesca|F|', 'Dalla Bernardina|Bernardo|B|', 'Beccaria|Francesca|F|', 'Capovilla|Giuseppe|G|', 'Baglietto|Maria Pia|MP|', 'Gagliardi|Alessandra|A|', 'Vignoli|Aglaia|A|', 'Canevini|Maria Paola|MP|', 'Perissinotto|Egle|E|', 'Francione|Stefano|S|']
D000293:Adolescent D017677:Age Distribution D001921:Brain D002648:Child D002675:Child, Preschool D003072:Cognition Disorders D015331:Cohort Studies D004569:Electroencephalography D004828:Epilepsies, Partial D005260:Female D006801:Humans D007223:Infant D007231:Infant, Newborn D008279:Magnetic Resonance Imaging D008297:Male D009483:Neuropsychological Tests D011446:Prospective Studies
Childhood epilepsy Behavior impairment Cognitive function Focal symptomatic seizures Intractable epilepsy