Etiology Analysis Of 1943 Children With Epilepsy And Related Factors With Epileptic Encephalopathy

Objective:Retrospectively analysis the etiology of 1943 children with epilepsy and discuss their related factors with epileptic encephalopathy.Methods:A retrospective survey was performed on 1943 children with epilepsy who were diagnosed in pediatric department of Qilu Hospital of Shandong University from January 2004 to January 2016 by self-designed questionnaire.The record was collected,which included children’s general information,physical examination,the medical history,assistant examinations,treatments and drug response.All the patients were followed up by more than 1 year.All patients were divided into epileptic encephalopathy group and non-epileptic encephalopathy group based on if they comorbid with progressive neurologic decline or not.Chi-square was used for count data comparison between two groups.All statistical analysis was carried out with SPSS 19.0 software.P values<0.05 were considered statistically significant.Results:In 1943 cases,consisting of 1151 male patients and 792 females,and the ratio was1.45:1.Age of patients ranged from 0 to 16 years old,70.5%of them were younger than three years.The median age of onset was one year and three months.In the aspect of etiology,genetic mutations were determined in 49 cases(2.52%).Structural causes were determined in 623 cases(32.06%),the most frequent structural causes were congenital encephalodysplasia,intracranial infection and brain injury in perinatal stage.Metabolic causes were confirmed in 43 cases(2.21%),in which methylmalonic acid,mitochondrial cytopathy and phenylketonuria were most common.Etiology in 1228 cases(63.2%)haven’t been clarified.The incidence of epileptic encephalopathy observed in our study was 26.7%with more than 1 year follow-up.There were statistically significant differences in epileptic encephalopathy group compared to non-epileptic encephalopathy group on the following factors,abnormal birth history(P=0.034),febrile convulsion(P<0.00001)age of onset(P<0.0001)and etiology classification(P<0.0001).However,family history of neurological diseases had no differences(P>0.05).In the structural causes,congenital encephalodysplasia(P=0.034)and brain injury ’in perinatal stage(P<0.0001)had statistically significant difference between two groups,whereas no difference in intracranial infection(P>0.05).Conclusions:1.The incidence of epilepsy were higher in the infant and pre-school children(<6 years old),most occurs under one year old,but decreased with age.The number of male patients is slightly more than females.2.In the known etiology,structural causes appeared to be the most common,in which congenital encephalodysplasia,intracranial infection and brain injury in perinatal stage as the main component.3.In the structural etiology,congenital encephalodysplasia and brain injury in perinatal stage were the main dangerous causes before age 3,but the rate of these causes declined with age,whereas intracranial infection become the most common cause of epilepsy in children over 3.4.Patients with epileptic encephalopathy commonly occurred in younger group.Abnormal birth history and congenital encephalodysplasia could increase risk of epileptic encephalopathy.Instead,patients with febrile seizures showed positive tendency(except the Dravet syndrome).5.Putting more efforts on perinatal health care and improving the screening for congenital malformation and metabolic diseases are important to decrease the incidence of epilepsy and improve population quality.