Long-term outcomes of childhood-onset epilepsy

描述(申请人提供)：癫痫影响1-2%的人口。所有新病例中有一半发生在婴儿期至青春期早期。癫痫发作的结果千差万别。癫痫可能是一种终生难治性疾病，也可能在几次癫痫发作后消失。然而，许多人在获得持久缓解之前，会在最初几年反复进行缓解-复发过程。与评估、治疗、管理、咨询、干预和潜在预防相关的两个问题知之甚少：1)在接受手术治疗的成人顽固性癫痫患者中，超过一半的人患有儿童期癫痫，然而，前瞻性研究发现，很少有儿童患有可通过手术治疗的顽固性癫痫。2)在其他神经学正常的成人中，儿童发作癫痫，其中许多人正在缓解和停药；与非癫痫对照组相比，教育和社会结果受到损害。对这两种观察结果的解释在现存的文献中并不明显。首先，数据仅来自对难治性患者的回顾分析。很少有儿童从发病到成年后接受手术的数据。其次，报告长期社会和教育结果的研究只描述了多年后的最终癫痫结果，从而忽略了通常复杂的缓解-复发过程，这种过程在10年后演变，以及从很小的时候就出现的行为和精神疾病的共同发病，甚至在癫痫发作之前。康涅狄格州的这项研究是一项正在进行的前瞻性队列研究，共有613名儿童(最初为1个月-15岁)在首次被诊断为癫痫时招募(1993-7年，中位数随访~10年)。随着队列成熟到青春期晚期/成年期早期，我们将进行两条线的调查：1)海马区疾病的存在和发展，其频率和确定局灶性癫痫患者最有可能发展为癫痫的因素；2)癫痫结局与精神、行为、社会、教育和健康相关生活质量的相关性，以及独立于癫痫变量的精神和行为状况解释社会和教育后果的程度的评估。康涅狄格州的这项研究特别适合于解决这些关于青春期癫痫发作的后果的问题。海马体体积、体积变化和T2松弛测量的检查将提供有关最常见的手术治疗癫痫的自然病史、确定和早期发现的第一个前瞻性信息。

DESCRIPTION (provided by applicant): Epilepsy affects 1-2% of the population. Half of all new cases arise in infancy through early adolescence. Seizure outcomes are highly varied. Epilepsy can be a life-long intractable disorder or may resolve after only a few seizures. Many individuals, however, follow a repeated remitting-relapsing course for the first several years before attaining lasting remission. Two issues relevant to evaluation, treatment, management, counseling, intervention, and potentially prevention are poorly understood: 1) More than half the adults with intractable epilepsy who are treated surgically have epilepsy of childhood onset, yet, prospective studies find few children with surgically treatable intractable epilepsy. 2) In otherwise neurologically normal adults with childhood onset epilepsy, many of whom are in remission and off medication; educational and social outcomes are impaired relative to non-epilepsy controls. Explanations for both observations are not evident in the extant literature. Firstly, data come from retrospective analyses of refractory patients only. Few data exist from children followed from onset to surgery in adulthood. Secondly, studies reporting long-term social and educational outcomes characterize only final seizure outcomes after many years thus ignoring an often complex remitting-relapsing process that evolves over >10 years as well as behavioral and psychiatric co- morbidity present from an early age, even predating the seizures. The Connecticut study is an ongoing prospective cohort of 613 children (initially 1 mo - 15 yr) recruited when first diagnosed with epilepsy (1993- 7, median follow-up ~10 years). As the cohort matures into late adolescence/early adulthood, we will pursue two lines of investigation: 1) Presence and progression of hippocampal disease, its frequency and factors that identify patients with focal epilepsy most likely to develop it; 2) Correlation of seizure outcomes with psychiatric, behavioral, social, educational, and health-related quality of life outcomes, and an assessment of the extent to which psychiatric and behavioral conditions, independent of seizure variables, explain social and educational outcomes. The Connecticut study is uniquely suited to address these questions concerning the consequences of childhood onset epilepsy in young adults. The examination of hippocampal volumetry, changes in volume and T2 relaxometry will provide the first prospective information about the natural history, determinates, and early detection of the most common form of surgically treated epilepsy.