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Biomedical subjects

E Wirrell

Publications and source records attributed to E Wirrell.

6 recordsLinked to original sources
PubMed2001

Prognostic significance of failure of the initial antiepileptic drug in children with absence epilepsy.

PURPOSE: In children with childhood absence epilepsy (CAE) and juvenile absence epilepsy (JAE), to determine the impact of failure of initial antiepileptic drug (AED) for lack of efficacy in eventual seizure control and long-term remission of epilepsy. METHODS: Centralized EEG records for the province of Nova Scotia allowed identification of all children seen with CAE or JAE between 1977 and 1985. Information regarding success or failure of initial AED in fully controlling seizures and long-term seizure control and remission of epilepsy was collected by patient questionnaire and chart review. RESULTS: Eighty-six of 92 eligible patients were followed up (75 CAE, 11 JAE). Initial AED treatment was successful in 52 (60%) of 86. Success tended to be greater for valproate (VPA) than for other AEDs (p = 0.07), and lower if generalized tonic-clonic or myoclonic seizures coexisted (p < 0.004 and p < 0.03). Terminal remission was more likely if the initial AED was successful than if it had failed (69% vs. 41%; p < 0.02). Compared with those in whom the initial AED was successful, subjects whose initial AED had failed were more likely to progress to juvenile myoclonic epilepsy (JME) at last follow-up (32% vs. 10%; p < 0.02) and to develop intractable epilepsy (17% vs. 2%; p < 0.04). CONCLUSIONS: Initial AED was successful in 60% of children with AE. If the first AED failed, the outcome was less favorable, with a lower rate of terminal remission and a higher rate of progression to JME and intractable epilepsy.

Adolescent↗
PubMed2001

Do cognitively normal children with epilepsy have a higher rate of injury than their nonepileptic peers?

The objective of this study was to determine if cognitively normal children with epilepsy have higher accidental injury rates than their age- and sex-matched friends without epilepsy and what factors may predict this. Patients 5 to 16 years old, with a developmental quotient >70, without major motor or sensory impairments, with a 1-year history of epilepsy and who either had a seizure or had been on antiepileptic drugs within the past year, were identified from the pediatric neurology database of the Royal University Hospital. Twenty-five of 31 cases and their best friend controls agreed to participate. Seizure-related factors including type, duration, frequency, timing, date of diagnosis, antiepileptic drug initiation and discontinuation, and specific types and total antiepileptic drugs used were assessed by interview. Questionnaires about accidental injury including type, number, severity, and, if applicable, injuries resulting from seizures, as well as general safety practices, activity restrictions, and presence of attention-deficit hyperactivity disorder, were completed by cases and controls. No significant differences in injury numbers (specific types or total) or severity were found, although a small number of epileptic children were very predisposed to injury. Seizure-related factors did not predict injury in cases. Safety practices were similar, and restrictions in cases were not excessive. Children with attention-deficit hyperactivity disorder had a higher injury rate, both in cases and controls. Cognitively normal children with epilepsy do not have a higher injury rate than their nonepileptic peers. If consciousness is impaired in seizures, extra supervision for swimming and bathing and restricted climbing heights are suggested. All other safety restrictions for epileptic children should follow those appropriate to nonepileptic children to allow a normal lifestyle.

Accidents↗
PubMed1999

Does status epilepticus in children cause developmental deterioration and exacerbation of epilepsy?

The aims of this study were to determine predictors of abnormal outcome, neurodevelopmental deterioration, new-onset epilepsy, refractory epilepsy, and recurrent status epilepticus in children presenting with status epilepticus. For all children presenting to Royal University Hospital, Saskatoon, Saskatchewan, Canada, with status epilepticus between January 1987 and December 1996, demographic data, details of status epilepticus (etiology, duration, treatment, and investigations), developmental milestones, seizures prior to and following status epilepticus, recurrent status epilepticus, and neurologic examination findings at status epilepticus and at follow-up were collected by chart review, patient interview, and neurologic examination. Neurodevelopmental outcome was determined for all subjects except those who died during the initial hospitalization. Predictors of new-onset epilepsy, refractory epilepsy, and recurrent status epilepticus were determined for children followed for 3 months or more after status epilepticus. At follow-up, 79% were abnormal neurologically. Predictors included etiology (nonfebrile or nonidiopathic), perinatal difficulties, preceding developmental delay, abnormal initial neurologic examination; and abnormal neuroimaging. Thirty-four percent showed neurodevelopmental deterioration; predictors included etiology (nonidiopathic or nonfebrile), young age at status epilepticus (12 months or less), and abnormal neuroimaging. Thirty-six percent with no history of seizures preceding status epilepticus developed epilepsy and 25% developed refractory epilepsy. Fifty percent of children had recurrent status epilepticus. In conclusion, very few children presenting in status epilepticus were normal at follow-up. Sequelae were seen predominantly in those with a nonidiopathic, nonfebrile etiology, whereas those with idiopathic or febrile status epilepticus did well.

Adolescent↗
PubMed1996

Incidence of epilepsy in childhood and adolescence: a population-based study in Nova Scotia from 1977 to 1985.

Data from a regional EEG laboratory allowed us to identify almost all children in Nova Scotia (population 85,000) with one or more unprovoked, afebrile seizures from 1977 through 1985. We then reviewed hospital and pediatric neurology physician charts to limit cases to those with two or more definite afebrile seizures between the ages of 1 month and 16 years. In all, 693 children developed epilepsy: typical childhood absence seizures (AS) (97), either generalized tonic-clonic (GTCs) or partial seizures either secondarily generalized or not (511), and other generalized seizure types, including infantile spasms (IS) as well as myoclonic, akinetic, tonic, and atypical AS (85). The incidence of epilepsy was 118 in 100,000 for children aged less than 1 year, 48 in 100,000 for those aged 1-5 years, 43 in 100,000 for those aged 6-10 years, and 21 in 100,000 for those aged 11-15 years. The incidence for each year of age between 1 and 10 years was remarkably constant (mean 46 in 100,000 +/- 7 SD). Comparison of the incidence rates showed significant differences for those aged less than one year as compared with all others, and for those aged greater than 10 years as compared with those aged 1-10 years. We conclude that the incidence of epilepsy is highest in the first year of life, plateaus in early childhood, and decreases markedly after age 10 years. The overall incidence of epilepsy in childhood is lower than that reported in previous studies.

Adolescent↗