Evaluation of Seizure Type and Etiology and Comorbidity of Drug-Resistant Focal Epilepsy of Children Rerferred to Tabriz Children Haspital

Abstract

About one-third of children's epilepsy is resistant to medications and about 60% of them are focal. Considering that surgery can be an alternative treatment for refractory focal epilepsy, this study was conducted to investigate seizure type, etiology, and comorbidity of medication-resistant focal epilepsy. MATERIAL AND METHODS: This descriptive cross-sectional study was conducted in 2021-2022 on 100 patients younger than 18 who underwent long term Video-EEG Monitoring (VEM) in 2017-2021 as a focal medication-resistant epilepsy in the neurology department of Tabriz Children's Hospital. Demographic and clinical information, patients’ history, seizure semiology, etiology, neuroimaging, and seizure onset zone were extracted from the patients’ files through a questionnaire and classified according to the international league against epilepsy (ILAE) 2017 seizure classification. RESULTS : The average age of the patients was 7.9 years. The most common types of seizures were: tonic (40%), automatism (30%), and clonic (12%) while 18% of the cases had Focal to Bilateral Tonic Clonic seizures (FBTCs). About 67% of patients had comorbidities, most commonly (55%), intellectual disability and developmental delay (ID, GDD). The etiology of 39% of the patients was known, the most common of which were structural (27%), genetic-structural (5%), and infectious-structural (5%). Forty patients (43.4%) had abnormal neuroimaging, mostly cortical developmental malformation (CDM) in 14 patients (15.2%) and post-vascular in 10 patients (10.8%). The seizure onset zone (SOZ) was in the left and right hemispheres in 66% and 22% of the patients, respectively, while 11% of the cases showed bifrontal SOZ with no clear focality. The most common seizure onset zone included temporal (34%), frontal (30%), lateralized (left or right hemisphere; 16%), central plus (11%), and posterior brain areas (temporo-parieto-occipital; 9%).‎