| Objective:To summarize the clinical characteristics, treatment and prognosis of absence seizures in children, to compare the difference between typical absence seizures (TAS) and atypical absence seizures (AAS) at the same time, in order to gain more experience and the experience of diagnosis and treatment of clinical.Methods:37 patients were selected for this follow-up survey, who were newly diagnosed with absence seizures of children in outpatient or inpatient between 2010 and 2014 September, including 19 cases of TAS, 18 cases of AAS, but without the special form of absence cases. Calls or by regular outpatient follow-up for 6 months of follow-up, further grouped by two group, retrospective analysis, TAS compared with AAS in the clinical characteristics, EEG and neuroimaging changes and treatment effect of the similarities and differences.The SPSS version 17.0 was used for statistical analysis. Statistical significance was accepted at p<0.05.The Fisher’s exact test were used to determine the associations among categorical data. Measurement data is described by the mean±standard deviation, maximum value and minimum value. Count data expressed as the number and percentage of cases.Result:(1) Among the 19 typical absence seizures,11 are females and 8 males, female:male=1.4:1.Among the 18 atypical absence seizures,8 are females and 10 are males, female:male=1:1.25. (2)The onset of TAS is age related. The average age of onset was 7.29±1.52 years old.Up to 89.4% of patients were 4-10 years old, account for the largest proportion. The average age of onset of AAS was 5.70±3.78 years old.50% patients were 4-10 years old. There is significant difference (p=0.013,<0.05) in TAS and AAS group with the onset age of 4-10. (3) 16 cases (84.2%) of TAS continued 5-30 seconds and the occurrence is 5-20 times a day in 12 cases (63.2%).12 cases (66.7%) of AAS continued more than 30 seconds and the occurrence is less than 5 times a day in 13 cases (72.2%). There were significant difference in both group (p<0.05). (4)Only 3 patients had GTCS among the 19 typical absence seizures.11 cases were diagnosed childhood absence epilepsy (CAE) according to the ILAE (2005) criteria and just 2 were juvenile absence epilepsy. Among the 18 atypical absence seizures,66.7% patients Combined with other type of seizures.1 case were Lennox-Gastaut syndrome and another one were Dravet syndrome. There is significant difference (p=0.003,<0.05) in TAS and AAS group with other type of seizures.(5) All patients in TAS group had no history of mental retardation or encephalitis. However, in AAS group,10 cases (55.6%) had mental retardation and 1 case had a history of Japanese encephalitis. There is significant difference (p=0.000,<0.01) in TAS and AAS group with mental retardation.(6) All patients in TAS group had no brain imaging abnormalities, but 43.8% cases (7/16) of AAS had brain imaging abnormalities. There is significant difference (p=0.002,<0.05) in TAS and AAS group with brain imaging abnormalities. (7) During typical absence seizures (TAS), the EEG shows generalized, regular, synchronous diffuse spike-and-wave discharges (SWD) with a frequency of more than 2.5 Hz. Interictal EEG maybe normal, or recorded the focal discharge, the SWD and theta or delta activity in occipital region. During atypical absence seizures (AAS), the EEG, which is more heterogeneous, shows diffuse, irregular SWD with a frequency of less than 3.0 Hz.Background usually abnormal. (8)In TAS group,83.3%(15/18) were seizures free after treatment but just 33.3% cases (5/15) were seizures free in AAS group. There is significant difference in TAS and AAS group (p<0.05).Conclusion:(1) The onset of TAS is age-related, little intellectual movement retardation and head imaging abnormalities, The duration of TAS is shorter and more frequent than AAS. Rarely associated with other types of seizures and EEG is special. Usually, the treatment and prognosis are favorable. (2) There is a significant difference of onset age in AAS, which often combined with mental retardation and brain imaging abnormalities. Although AAS is less frequent, but continued longer and more serious than TAS. AAS is mostly as part of epileptic encephalopathies and combined with other seizure types. The EEG is more heterogeneous and poor response to treatment and prognosis. (3)Both TAS and AAS are in need of treatment with Antiepileptic drugs, especially in AAS.The fist-line medications are VPA, ESM and LTG, followed by CNP, TPM, Rufinamide. Combined medication is necessary if not satisfied with the treatment results. But Phenytoin, carbamazepine and oxcarbazepine can cause absence aggravation and should be avoid in clinical application. |
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