Investigators from University of Chieti and several other centers in Italy conducted a multicenter retrospective 36-month follow-up study of the electroclinical course of epilepsy in all children with typical absence seizures (TAS) starting in the first 3 years of life. Two groups of patients were compared: 1) 111 who fulfilled Panayiotopoulos’s criteria for childhood absence epilepsy (CAE) classified as having pure early onset absence epilepsy (P-EOAE), and 2) 77 who did not satisfy the criteria and were classified as nonpure EOAE (NP-EOAE). The 2 groups were also stratified according to the number of antiepileptic drugs used to obtain initial seizure control.

Patients with pure EOAE showed earlier initial seizure control (p=0.030) and better seizure-freedom (p=0.004) than those with NP-EOAE. P-EOAE patients had no mutation in SLC2A1 gene and no abnormal neuroimaging. Among the NP-EOAE patients, those receiving tritherapies showed increased risk of structural brain abnormalities (p=0.001) or SLC2A1 mutations (p=0.001) but fewer myoclonic features (p=0.031) and worse seizure-free survival (p=0.047) than those treated with mono-and biotherapy. Children with NP-EOAE had an increased risk of relapse during follow-up compared to P-EOAE patients. [1]

COMMENT. Children <3 years old with early onset TAS who meet the modified Panayiotopoulos’s criteria for childhood absence epilepsy (CAE) have a good prognosis, whereas those not meeting the criteria have an increased risk of relapse at long-term follow-up.

Panayiotopoulos’s definition of CAE [2] is abridged as follows: 1) age at onset between 4 and 10 years (modified to within the first 3 years for this study); 2) normal neurologic exam; 3) brief (4-20 sec) and frequent (many per day); 4) EEG 3-4 Hz spike and slow-wave complexes. Exclusion criteria include 1) other types of seizure; 2) eyelid myoclonia, perioral myoclonia, head and limb myoclonic jerks; 3) EEG polyspikes; 4) photic precipitation of clinical seizures.