Epilepsy in Maltese children.

Abstract

Purpose: To determine the point prevalence of active childhood epilepsy in Malta with the primary objective of health service planning in this population. The study also aimed at verifying the applicability of the ILAB classification of seizures, and epilepsies / syndromes in this group of children. Methods: A cross-sectional descriptive survey of children 0-15 years with "active" epilepsy was carried out among residents of Malta. Children with a diagnosis of epilepsy (recurrent unprovoked seizures) who had experienced a seizure or who had received antiepileptic medication in the preceding 5 years were considered to be active prevalence cases. The age- and sex-specific prevalence rates of epilepsy, type of seizures, epilepsies and recognisable epileptic syndromes were determined using the latest ILAB International Classification of Epileptic Seizures (ICES, 1981) and Epilepsies and Epileptic Syndromes (ICE, 1989). Results: Two hundred and five children fulfilled the criteria of active epilepsy giving a prevalence rate of 2.4211 ,000 population in children from birth through 15 years of age (95 % Cl = 2.1-2.79) on January 1, 1999. The proportion of boys to girls was 1.3: 1. According to ICES / ICE, seizures were classifiable with certainty in 99% of cases and epilepsy syndromes in 70% of cases. Among the syndromes, cryptogenic and symptomatic partial syndromes occurred in 35%, other generalized idiopathic epilepsies in 11%, childhood absence in 7%, Lennox Gastaut in 6%,West syndrome in 5% and benign childhood epilepsy with centrotemporal spikes (BECT) in 4%. Epilepsy was intractable in 26% of all cases and correlated significantly with symptomatic aetiology, early onset of epilepsy, as well as with additional neuroimpairments. The aetiology was regarded to be remote symptomatic in 39%, cryptogenic in 22% and idiopathic in 32%. Perinatal asphyxia, trauma and brain malformations were the three most common aetiological factors identified accounting for half of the cases with remote symptomatic epilepsy. Almost all children (91%) were on anticonvulsant medication; 70% were on monotherapy while 21 % were on polytherapy. Additional neuroimpairments were present in 106 (52%) of children. Learning disability was the commonest identified neuroimpairment with 36% of children functioning within the mental retardation range. Conclusions: The ILAE classification for seizures (ICES) was found satisfactory in the large majority of cases. However, since a considerable number of cases fell into the heterogeneous non-specific categories of the ICE, the value of present epilepsy/syndrome classification is limited in terms of prediction of prognosis, and indication for special investigations in individual cases. Although epilepsy appears to be a low prevalence condition it is more often associated with the burden of other neuroimpairments, particularly learning difficulties. This often has a considerable impact on children and their families. Health care service is but one of the network of services proposed to meet the needs of children with epilepsy. Children with epilepsy require optimal treatment with the minimal use of drugs, careful educational monitoring, realistic expectations from parents and teachers and close liaison between doctors, parents and schools.

Key Words: Epilepsy - Epileptic syndromes - Prevalence - Classification - Children