Retrospective evaluation of clinical, electroencephalography (EEG) characteristics and response to treatment in absence epilepsy patients

This study aimed to determine the demographic characteristics, initial complaints, age of first seizure, age of diagnosis, EEG and interictal focal findings, imaging methods and findings, potential side effects of drug treatment, efficacy of drugs used, and psychiatric evaluations of patients diagnosed with absence epilepsy in our clinic, and to reveal the differences between CAE and JAE with these variables. In our study, 48 cases between the ages of 0-18 who were diagnosed with Absence Epilepsy in the Child Neurology Polyclinic of Ankara University Faculty of Medicine, Department of Paediatrics, between January 2000 and January 2023 were retrospectively evaluated. SPSS 11.5 program was used for data analysis. In our study, 48 patients were evaluated. The mean age of the patients was 17.5±7.2 years, with 70.8% females and 29.2% males. Febrile convulsion history was present in 8.3% of the patients, accompanying additional diseases in 18.7%, consanguineous marriage in 10.4%, and family history of epilepsy in 16.7%. While the age of the first seizure was 8.3±2.9 years, the age of diagnosis was 8.6±3.0 years. The initial complaint in 95.8% of the patients was staring, while syncope was present in 4.2%. 95.8% of the neurological examinations were normal. Seizures accompanying absence epilepsy were detected in 10.4% of the patients, and all of them were JTCN. No myoclonic seizures were observed. Blank staring was observed in all 48 patients, brief eye blinking in 14.6%, automatisms in 16.7%. Myoclonus was not observed in any patient. The median duration of seizures was observed to be 6 seconds. In the EEG, focal focus was present in 45.8% of the 48 patients, with the rate of patients with a single focal focus being 10.4% and the rate of patients with multifocal focus being 35.4%. As a focal focus in the EEG, bilateral frontal area was observed in 36.5%, unilateral frontal area in 9.1%, bilateral occipital area in 22.7%, and unilateral occipital area in 9.1% of the patients. 3 Hz generalized spike-and-wave activity was detected in ictal EEG in 87.5% of the patients, and 4 Hz generalized spike-and-wave activity was detected in 12.5%. 85.4% of the control EEGs taken 2 years after the commencement of treatment were normal. 75% of the patients were found to have undergone brain MR as an imaging method. Abnormality was observed in the MR of 18.7% of these patients. Valproic acid treatment was started for 87.5% of the patients as the initial treatment. Ethosuximide and lamotrigine were started for other patients. The rate of patients followed without medication was 2.1%. Changes were made in the treatment of 31.2% of the patients at the initial treatment. The rate of patients whose medication was changed due to drug side effects was 2.1%, and the rate of patients whose medication was changed due to unresponsiveness/partial response to treatment was 29.2%. Medication was changed as a treatment arrangement in 10.4% of the patients, and the rate of patients to whom medication was added was 18.7%. Treatment compliance was observed in 97.9% of the patients, and only one patient had non-compliance to treatment. The average duration of treatment for the patients was 3.60±2.52 years. Side effects were observed in some of the patients receiving valproic acid treatment: headache in 4.2%, urinary incontinence in 4.2%, hair loss in 2.1%, weight gain in 6.2%, tremor in 2.1%, rash in 2.1%, elevated transaminases in 2.1%, and gastrointestinal side effects in 2.1% of the patients. Psychiatric evaluation was performed in 16.7% of the patients, and attention deficit was observed in 37.5% and learning difficulties in 25% of these patients. Focal focus was detected in the interictal EEG of 45.7% of 35 patients with CAE and 46.2% of 13 patients with JAE. Finally, by evaluating the response to treatment at the sixth month after antiepileptic treatment; in 58.3% of 12 patients who continued to have seizures; and in 41.7% of 36 patients without seizures a focal focus was detected in inter-ictal EEG. However, this difference was not statistically significant.