A low Apgar score at 5 minutes, neonatal seizures, focal-onset epilepsy, and focal slowing on electroencephalogram (EEG) are risk factor variables that cumulatively form an accurate model for predicting the risk for drug-resistant epilepsy in children with cerebral palsy. This is according to results of a study in the Journal of Child Neurology.
The study was a single-center, observational, retrospective chart review of 118 children with cerebral palsy and either drug-resistant epilepsy (n=52) or controlled epilepsy (n=66). Several clinical variables and patient characteristics were analyzed regarding their association and the incidence of drug-resistant epilepsy.
Predictors of drug-resistant epilepsy included a low Apgar score (1-4) at 5 minutes (odds ratio [OR], 3.47; 95% CI, 1.24-9.72; P =.01), neonatal seizures (OR, 3.53; 95% CI, 1.09-11.47; P =.03), focal-onset epilepsy (OR, 3.56; 95% CI, 1.49-8.49; P =.004), and focal slowing on EEG (OR, 5.47; 95% CI, 1.64-18.2; P =.006). The combination of all 4 predictors resulted in the best predictive model for drug-resistant epilepsy, demonstrated by an area-under-the-receiver operating characteristic curve value of 0.840.
As it pertains to functioning and therapeutic outcomes, individual variables that occurred at a higher frequency in patients with drug-resistant epilepsy included intellectual disability (P =.01), attendance of a special education system (P =.01), having received a higher number of antiepileptic drugs that failed (P <.001), adherence or attempt at adherence to a ketogenic diet (P <.001), and having undergone vagal nerve stimulation (P <.02) or surgery for epilepsy (P <.02).
Limitations of the study included its retrospective design, heterogeneity of the cerebral palsy and epilepsy etiologies, and the small sample sizes in both groups.
According to the investigators, this study may assist healthcare practitioners to “complete a clinical picture of ‘high-risk epilepsy’ and thereby further assist in the consideration of alternative therapeutic avenues in reaching the goal of reducing the burden of poor seizure control in children with cerebral palsy.”
Tokatly Latzer I, Blumovich A, Sagi L, Uliel-Sibony S, Fattal-Valevski A. Prediction of Drug-Resistant Epilepsy in Children With Cerebral Palsy [published online November 4, 2019]. J Child Neurol. doi: 10.1177/0883073819883157