Long-term outcomes of childhood-onset epilepsy

描述（由申请人提供）：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。癫痫发作的结果差别很大。癫痫可能是一种终生难治性疾病，也可能在几次发作后就会消退。然而，许多人在获得持久的缓解之前，在最初的几年里经历了反复的缓解-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尚不清楚：1)半数以上接受手术治疗的成人顽固性癫痫患者为儿童期癫痫，然而，前瞻性研究发现手术治疗的顽固性癫痫患儿很少。2)其他神经功能正常的儿童期癫痫成人，其中许多人处于缓解期和停药期；与非癫痫控制相比，教育和社会成果受到损害。对这两种观察结果的解释在现有文献中并不明显。首先，数据仅来自难治性患者的回顾性分析。很少有儿童从发病到成年手术的数据。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发作结果，从而忽略了通常复杂的缓解-复发过程，该过程发展超过10年，以及从早期甚至在癫痫发作之前就存在的行为和精神共发病。康涅狄格研究是一项正在进行的前瞻性队列研究，招募了613名首次诊断为癫痫的儿童（最初为1个月- 15岁）（1993- 7，中位随访~10年）。随着队列进入青春期晚期/成年早期，我们将进行两方面的调查：1)海马疾病的存在和进展，其频率和确定局灶性癫痫患者最可能发展为该病的因素；2)癫痫发作结果与精神、行为、社会、教育和健康相关生活质量结果的相关性，并评估独立于癫痫发作变量的精神和行为状况在多大程度上解释社会和教育结果。康涅狄格的研究是唯一适合解决这些问题有关的后果儿童癫痫发作的年轻人。海马体体积测量、体积变化和T2弛豫测量将提供关于最常见的手术治疗癫痫的自然病史、确定和早期检测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.