Background: Seizures in childhood absence
epilepsy (CAE) are usually easily controlled with anti-seizure medications
(ASMs). Factors predictive of treatment resistance remain unclear. Our
objectives were to assess prevalence of neuropsychiatric problems and
factors influencing refractoriness in a cohort of CAE at a single centre.
Methods: We retrospectively reviewed patients
with CAE (ILAE 2017 classification) diagnosed between January 1999 and
December 2016 with at least 1-year follow-up. Treatment resistance was
defined as failure to respond to two or more appropriate ASMs. Exclusion
criteria included eyelid myoclonia with absence, myoclonic absence, and
generalized tonic-clonic (GTC) seizure before developing absences.
Results: The study population comprised 164
patients (65 males) 6.25-year-old on average at absence onset. 22% had
treatment-resistant seizures. The first ASM was Ethosuximide in 63.4%,
Valproic acid in 23.2%, and Lamotrigine in 6.7%. Statistical differences
between response groups included developing a second seizure type
specifically GTC, the second and third ASM, and absence of EEG
normalization. At last follow-up, 43.3% of children were seizure-free off
ASMs. 32.9% of children had learning disabilities, 28% ADHD, and 12.8 %
anxiety. Conclusions: 22% of children with CAE had
treatment-resistant seizures. Photoparoxysmal response was not predictive of
treatment resistance. Neuropsychiatric problems were common with learning
disabilities increased with refractory absences.