Clinical And Functional Imaging Study Of Childhood Absence Epilepsy

Part Ⅰ Clinical Significance of Two Diagnostic Criteria for Childhood Absence EpilepsyObjective Childhood absence epilepsy (CAE) is one of the most common epilepsy syndromes which onset during the childhood. So far, there two criteria for CAE which were proposed by the International League Against Epilepsy (ILAE) in1989and2005years, respectively. Our aim was to investigate the clinical significances of two diagnostic criteria for CAE according to our patients’data and clinical features.Method We compared the clinical and electroencephalography features between two groups patients with childhood absence epilepsy diagnosed according to criteria proposed by ILAE in1989and2005years, respectively.Results The seizure duration of the patients diagnosed by1989criteria is shorter than patients diagnosed according to2005criteria. Seizure-control rate by multidrug and evoking-positive rate in EEG of patients diagnosed by ILAE1989is higher than patients diagnosed according to2005criteria.Conclusions The criteria of ILAE2005can ensure the homogeneity of patients with easier to control seizures. Part Ⅱ BOLD-fMRI in Childhood Absence EpilepsyPurpose:We try to elaborate the metabolic changes of brain regions during absence seizure in patients with childhood absence epilepsy.Methods:All patients underwent EEG-fMRI scanning in ictal and interictal phase, we compared the BOLD (blood oxygen level dependent) signal by general linear model (GLM).Results:16patients were included this study and52pieces data were available. Thalamus, frontal cortex, primary visual cortex and motor cortex were presented increasing BOLD signal, whereas parietal lobe and basal ganglia featured by decreasing BOLD signal.Conclusion:Thalamus and frontal cortex were fundamental structures involved in pathogenesis of childhood absence epilepsy. Part III Long-Term Seizure Outcome of Childhood Absence Epilepsy:A Systematic Review and Meta-AnalysisPurpose:To evaluate the proportion of seizure freedom or other outcomes in patients with childhood absence epilepsy (CAE).Methods:We performed a systematic review and meta-analysis of the published evidence of how many patients in similar studies become seizure-free and evolve to other seizure types or comorbidities. Of233potentially eligible research papers reviewed in full text,19fulfilled eligible criteria. All19papers reported evidence based on International League Against Epilepsy (ILAE) criteria1989, and three of19studies reported the results based on ILAE2005criteria. We gathered the following data from all literatures:baseline information, diagnostic criteria, drug medication, and length of follow-up and main results on outcome.Key findings:We identified19cohort studies, totaling1,669patients, and7581.46patients-years of follow-up. The pooled seizure freedom proportion were74.3%(95%CI:[66.8%,80.6%]) and89.9%(95%CI:[0.580,0.983]) in patients who fulfilling ILAE1989and2005years, respectively. Therefore, diagnostic criteria are vital influencing factors for epilepsy long-term prognosis. The main determining factors include age at onset, EEG features, and response to initial medications.Significance:The majority of CAE patients have a good prognosis with seizure freedom and without comorbidities. The ILAE2005CAE criteria tend to ensure patients with high homogeneities with rare comorbidities and good long-term prognosis.