Prognostic factors of refractory epilepsy in children

Main Article Content

Ramzi Ramzi
Yati Soenarto
Sunartini Sunartini
M Hakimi


Background Epilepsy is one of the most common pediatric
neurological disorders. Twenty percent of patients will develop
refractory epilepsy. Early identification of refractory epilepsy will
be helpful to conduct adequate counseling and selecting patients
who need more intensive investigation and treatment.
Objective To identify the clinical characteristics and other factors
that are related to refractory epilepsy in children.
Methods We conducted a case control study in patients of two to
18 years old with epilepsy that admitted to Dr. Sardjito Hospital.
There were 4 7 children with refractory epilepsy compared with
122 subjects who have been one year free of seizure.
Results Strong association had been noted between refractory
and several clinical factors: early onset of seizure, high initial
seizure frequency, neonatal asphyxia, symptomatic etiology, status
epilepticus, abnormal neurodevelopmental status, and early
breakthrough seizures after treatment initiation. On multivariate
analysis, more than 20 seizures prior to treatment initiation (OR
3.40, 95% CI 1.03 to 11.3), and more than three seizures in the
subsequent six month after treatment initiation (OR 16.02, 95%
CI 4.98 to 51.5) were independent prognostic factors related to
refractory epilepsy.
Conclusion Children who present high frequency seizures at
onset and more than 3 breakthrough seizures subsequent to six
month after treatment have risks of developing refractory epilepsy.

Article Details

How to Cite
Ramzi R, Soenarto Y, Sunartini S, Hakimi M. Prognostic factors of refractory epilepsy in children. PI [Internet]. 15Sep.2016 [cited 28Sep.2020];48(5):269-3. Available from:
Author Biographies

Ramzi Ramzi

Department of Child Health, Medical School, Gadjah Mada
University, Yogyakarta, Indonesia

Yati Soenarto

Department of Child Health, Medical School, Gadjah Mada
University, Yogyakarta, Indonesia

Sunartini Sunartini

Department of Child Health, Medical School, Gadjah Mada
University, Yogyakarta, Indonesia

M Hakimi

Department of Obstetrics and Gynecology, Medical School,
Gadjah Mada University, Yogyakarta, Indonesia
Received 2016-09-11
Accepted 2016-09-11
Published 2016-09-15


1. WHO. Neurological disorders, including epilepsy, WHO Fact
sheet 2007.
2. Sander JW The natural history of epilepsy in the era of new
antiepileptic drugs and surgical treatment. Epilepsia 2003;44
Suppl 1:17-20.
3. Kwan P, Brodie MJ. Refractory epilepsy: a progressive, intrac-
table but preventable condition? Seizure, 2002; 11:77-84.
4. Revathan E, Gilliam F. Lost years. Delayed referral for
surgically treatable epilepsy. Neurology 2003;61:432-3.
5. Chawla S, Aneja S, Kashyap R, Mallika V. Etiology and
clinical predictors of intractable epilepsy. Pediatr Neurol
2002;27: 186-91.
6. Gururaj A, Sztriha L, Hertecant J, Eapen V. Clinical
predictors of intractable childhood epilepsy. J Psychosom
Res 2006;61 Suppl3:343-7.
7. Akhondian J, Heydarian F, Jafari SA. Predictive factors of
pediatric intractable seizures. Arch Iranian Med 2006;9 Suppl
8. Commission on Classification and Terminology of the
International League Against Epilepsy. Proposal for revised
clinical and electroencephalographic classification of
epileptic seizures. Epilepsia 1981;22:489-501.
9. Commission on Classification and Terminology of the
International League Against Epilepsy. Proposal for revised
classification of epilepsy and epileptic syndromes. Epilepsia
10. Commission on Epidemiology and Prognosis, International
League Against Epilepsy. Guidelines for epidemiologic studies
in epilepsy. Epilepsia 1993;34:592-6.
11. Oskoui M, Webster RI, Zhang X, Shevel MI. Factors
Predictive of Outcome in Childhood Epilepsy. J Child Neurol
12. Camfield CS, Camfield PR, Gordon K, Dooley J. Does the
number of seizure before treatment influence ease of control
or remission of childhood epilepsy? Not if the number is 10
or less. Neurology 1996;46:41-4.
13. Jarrar RG, Buchhalter JR. Therapeutics in pediatric epilepsy,
Part 1: The new antiepileptic drugs and the ketogenic diet,
Mayo Clin Proc 2003;78:359-70
14. French JA, Kanner AM, Bautista J et al. Efficacy and
tolerability of the new antiepileptic drugs II: Treatment of
refractory epilepsy. Neurology 2004;62:1261-73
15. Berg AT, Kelly MM. Defining intractability: Comparisons among
published definitions. Epilepsia 2006;4 7 Suppl2:431-6.
16. K wan P, Brodie MJ. Early identification of refractory epilepsy.
N Engl J Med 2000;342:314-9.
17. Kwong KL, Sung WY, Wong SN, So KT. Early predictors of
medical intractability in childhood epilepsy. Pediatr Neurol
18. Kwan P, Brodie MJ. Drug treatment of epilepsy: when
does it fail and how to optimize its use. CNS Spectrums
2004;9: 110-9.
19. Lamdhade SJ, Taori GM. Study of factors responsible for
recurrence of seizures in controlled epileptics for more than
1 1/2 years after withdrawal of antiepileptic drugs. Neurol India
20. Arts WFM, Geerts AT, Brouwer OF, Peter ACB, Stroink H,
Donselaar CA V The early prognosis of epilepsy in childhood:
the prediction poor outcome. the Dutch study of epilepsy in
childhood. Epilepsia 1999;40:726-34.
21. Dlugos DJ, Sammel MD, Strom BL, Farrar JT. Response to
first drug trial predicts outcome in childhood temporal lobe
epilepsy. Neurolog 2001;57:2259-64.
22. Camfield PR, Camfield CS, Gordon K, Dooley JM. If a
first antiepileptic drug fails to control a child's epilepsy,
what are the chances of success for the next drug. J Pediatr
23. Morrell F. Secondary epileptogenesis in man, Arch Neurol
1985;42 Suppl4:318-35.
24. Berg AT, Shinnar S, Levy SR, Testa FM, Rapaport SS,
Beckerman B. Early development of intractable epilepsy in
children: A prospective study. Neurology 2001;56: 1445-52.
25. Sillanpaa M. Remission of seizures and predictors of intracta-
bility in long-term follow-up. Epilepsia 1993;34:930-6.
26. Berg AT, Levy SR, Novotny EJ, Shinnar S. Predictors of
intractable epilepsy in childhood: A case-control study.
Epilepsia 1996;37 Suppll:24-30.
27. Maytal J, Shinnar S, Moshe SL, Alwarez LA. Low morbidity
and mortality of status epilepticus in children. Pediatrics