Factors that influence the prognosis of cryptogenic partial seizures were determined in 233 patients (136 male, 97 female) followed at the outpatient clinic of Shanghai Xin Hua Hospital, Shanghai, China. The mean age of seizure onset was 6 years (range, 3 months to 12 years), and the mean duration of follow-up was 4.5 years (range, 2-13 years). Partial seizures were simple in 41 (17.6%), complex in 162 (69.5%), and complex partial/generalized in 30 (12.9%). Antiepileptic drugs were used as monotherapy in 194 patients, and polytherapy in 39 (2 drugs in 29 and 3 or more in 10). Response was good in 198 (85%): complete control in 71.7%, reduction of seizures of >50% in 13.3%, and poor or no response in 15%. The prevalence of poor control was correlated with young age of onset (28% of 50 children <3 years age vs 8% of 183 >3 years; P=0.03). Poor control was also related to seizure frequency (P<0.001), and seizure type (P<0.001); control was worse in those with >3 seizures/month, and in patients with partial seizures and secondary generalization. No correlation was observed between the location of an EEG focal abnormality and response to therapy. In 24 patients (10% of series) with autonomic symptoms, similar to Panayiotopoulos syndrome, the prognosis was not different from that of patients with motor symptoms. Seizure prognosis was not related to duration of seizure disorder, time to starting seizure treatment, and total number of seizures before treatment. [1]

COMMENT. Young age at seizure onset, a high initial seizure frequency, and partial seizures with secondary generalization are predictors of a poor response to antiepileptic medication in children with partial seizures.