Several Factors Predict Recurrent Febrile Seizures

SEATTLE—Complex febrile seizures, a family history of febrile seizures, male gender, and early onset of the first febrile seizure may increase the risk of recurrent febrile seizures, according to investigators.

“Abnormal EEG findings and low parental educational status may be new prognostic indicators,” reported Min-su Oh and Seung Hyo Kim from Jeju National University, Republic of Korea. “However, further investigation using larger populations and a prospective design is needed to confirm the validity of these prognostic factors.”

The researchers retrospectively reviewed medical records of 293 patients whose first febrile seizure developed between ages 3 months and 5 years. All subjects had visited the outpatient clinic or were admitted to the pediatric department of the Jeju National University Hospital for a first febrile seizure between March 2007 and May 2013. A recurrent febrile seizure was defined as a febrile seizure that occurred more than twice. Patients who had evidence of intracranial infection or an unprovoked seizure before the first febrile seizure were excluded.

The investigators analyzed variables such as age, gender, birth history, body temperature at onset of first febrile seizure, presence of complex febrile seizure or epilepsy (first-degree relatives), EEG findings, the family’s economic status, and parents’ educational level.

A total of 293 patients (178 boys) were included. Mean follow-up duration since onset of the first febrile seizure was 41.8 months. Mean age was 60.7 months. Average age at the first febrile seizure was 18.9 months. Patients had an average of 3.6 febrile seizure attacks, and family histories of febrile seizures and epilepsy were observed in 82 (28.0%) and 22 (7.5%) patients, respectively. A total of 130 (44.4%) patients had a complex febrile seizure, while 33.8% developed a febrile seizure before age 1; 60.8% had a body temperature less than 39° C at the onset of their first febrile seizure, and 12.6% had neurodevelopmental delay.

Patients were grouped into those who had fewer than three febrile seizures and those who had more than two attacks. “Parameters such as maternal age at childbirth, gestational age, mode of delivery, birth weight, family’s low economic status, and family history of epilepsy did not differ significantly between the groups,” noted the researchers.

EEG was performed in 69.6% of participants. Information about educational status for both parents was collected in 71.3% of subjects. “These two variables were not included in the multivariate model because these numbers were not considered representative of the whole sample,” the investigators explained.

After multivariate analysis was conducted, several parameters yielded statistically significant findings—complex febrile seizures (odds ratio [OR, 3.69),]family history of febrile seizures (OR, 3.10), male gender (OR, 2.44), and early onset of the first febrile seizure (younger than age 1 year; OR, 1.89).

—Colby Stong

Epilepsy Surgery Is Safe and Effective After Five-Year Follow-up
Nearly 70% of patients with medically intractable epilepsy were seizure-free five years after undergoing standard temporal lobectomy or selective amygdalohippocampectomy (SAH), according to Yvette Marquez, MD, from the University of Southern California (USC), and colleagues.

The investigators reviewed data from 131 patients with medically intractable temporal lobe epilepsy who underwent standard temporal lobectomy or SAH between 2004 and 2013 at the Los Angeles County–USC Medical Center and Keck Medical Center. Fifty patients who had follow-up of at least five years were included in the analysis. The rate of seizure cure after surgical intervention was categorized using International League Against Epilepsy classification.

Dr. Marquez’s group found that 69.2% of patients were completely seizure-free with no auras, 11.5% of patients had one to three seizure days per year with or without auras, and 19.2% of patients had one to four seizure days per year or a 50% seizure reduction per year with or without auras. Favorable seizure outcomes in the clinical setting were defined as having at least a 50% reduction in seizures postoperatively.

“Our experience with standard temporal lobectomy and SAH in the treatment of medically intractable epilepsy has been a favorable one,” said the researchers. “Moreover, the overall seizure burden decreased dramatically at five years postsurgery for all 50 patients who underwent surgical intervention. It remains clear that standard temporal lobectomy or SAH is a safe and well-tolerated primary or adjunctive treatment in the surgical management of epilepsy.”

—Colby Stong

Brivaracetam May Benefit Patients With Poorly Controlled Seizures
Daily doses of 100 mg and 200 mg of brivaracetam are well tolerated and may reduce seizure frequency when administered as adjunctive therapy in adults with refractory epilepsy and partial-onset seizures, according to results from a phase III clinical trial.

“The two primary outcomes in this study evaluating adjunctive brivaracetam in the treatment of partial-onset seizures in adults with epilepsy were statistically significant and clinically relevant,” said Pavel Klein, MD, Director of the Mid-Atlantic Epilepsy and Sleep Center in Bethesda, Maryland.

Dr. Klein and colleagues performed a multicenter, randomized, double-blind, placebo-controlled study. The goal was to analyze the efficacy and safety of brivaracetam, an analog of levetiracetam, in adults with poorly controlled partial-onset seizures.

The researchers administered doses of 100 mg/day or 200 mg/day of brivaracetam as an adjunctive treatment to 764 adults who were taking one or two concurrent antiepileptic drugs (AEDs). More than 80% of participants had failed at least two previous AEDs, and approximately 47% reported failing five or more AEDs. Individuals who had taken levetiracetam within 90 days of study initiation were excluded.

Patients participated in an eight-week baseline period followed by 12 weeks of brivaracetam treatment. After the 12-week treatment period, long-term follow-up was conducted to monitor the drug’s efficacy and safety. Data from seizure diaries indicated a clinically relevant reduction in the frequency of partial-onset seizures during a 28-day period among patients taking either dose of brivaracetam.

Patients taking 100 mg of brivaracetam had a 22.8% reduction in seizure frequency over a 28-day period. This was similar to the 23.2% reduction in seizure frequency observed in patients taking 200 mg of brivaracetam. The findings were consistent regardless of previous levetiracetam exposure.

A total of 23 patients treated with brivaracetam, including 13 (5.4%) taking 100 mg and 10 (4%) taking 200 mg, achieved complete freedom from all seizure types. Two patients in the placebo group achieved seizure freedom.

In general, the treatment was well tolerated. Between 7% and 19% of patients taking 100 mg, and between 8% and 16% of patients taking 200 mg, had adverse events, compared with 3% to 8% of patients in the placebo group. The most common adverse

“Levetiracetam is a great medication that is usually well tolerated, but it has got potential for psychiatric side effects,” said Dr. Klein. Approximately 10% of people receiving levetiracetam have irritability. “The rate of irritability in this study was 2% for both the 100-mg dose and the 200-mg dose, versus 1% for placebo. If brivaracetam turns out to be a more friendly version of levetiracetam, then that would be a helpful thing,” Dr. Klein concluded.

—Erik Greb

SEATTLE—Complex febrile seizures, a family history of febrile seizures, male gender, and early onset of the first febrile seizure may increase the risk of recurrent febrile seizures, according to investigators.

“Abnormal EEG findings and low parental educational status may be new prognostic indicators,” reported Min-su Oh and Seung Hyo Kim from Jeju National University, Republic of Korea. “However, further investigation using larger populations and a prospective design is needed to confirm the validity of these prognostic factors.”

The researchers retrospectively reviewed medical records of 293 patients whose first febrile seizure developed between ages 3 months and 5 years. All subjects had visited the outpatient clinic or were admitted to the pediatric department of the Jeju National University Hospital for a first febrile seizure between March 2007 and May 2013. A recurrent febrile seizure was defined as a febrile seizure that occurred more than twice. Patients who had evidence of intracranial infection or an unprovoked seizure before the first febrile seizure were excluded.

The investigators analyzed variables such as age, gender, birth history, body temperature at onset of first febrile seizure, presence of complex febrile seizure or epilepsy (first-degree relatives), EEG findings, the family’s economic status, and parents’ educational level.

A total of 293 patients (178 boys) were included. Mean follow-up duration since onset of the first febrile seizure was 41.8 months. Mean age was 60.7 months. Average age at the first febrile seizure was 18.9 months. Patients had an average of 3.6 febrile seizure attacks, and family histories of febrile seizures and epilepsy were observed in 82 (28.0%) and 22 (7.5%) patients, respectively. A total of 130 (44.4%) patients had a complex febrile seizure, while 33.8% developed a febrile seizure before age 1; 60.8% had a body temperature less than 39° C at the onset of their first febrile seizure, and 12.6% had neurodevelopmental delay.

Patients were grouped into those who had fewer than three febrile seizures and those who had more than two attacks. “Parameters such as maternal age at childbirth, gestational age, mode of delivery, birth weight, family’s low economic status, and family history of epilepsy did not differ significantly between the groups,” noted the researchers.

EEG was performed in 69.6% of participants. Information about educational status for both parents was collected in 71.3% of subjects. “These two variables were not included in the multivariate model because these numbers were not considered representative of the whole sample,” the investigators explained.

After multivariate analysis was conducted, several parameters yielded statistically significant findings—complex febrile seizures (odds ratio [OR, 3.69),]family history of febrile seizures (OR, 3.10), male gender (OR, 2.44), and early onset of the first febrile seizure (younger than age 1 year; OR, 1.89).

—Colby Stong

Epilepsy Surgery Is Safe and Effective After Five-Year Follow-up
Nearly 70% of patients with medically intractable epilepsy were seizure-free five years after undergoing standard temporal lobectomy or selective amygdalohippocampectomy (SAH), according to Yvette Marquez, MD, from the University of Southern California (USC), and colleagues.

The investigators reviewed data from 131 patients with medically intractable temporal lobe epilepsy who underwent standard temporal lobectomy or SAH between 2004 and 2013 at the Los Angeles County–USC Medical Center and Keck Medical Center. Fifty patients who had follow-up of at least five years were included in the analysis. The rate of seizure cure after surgical intervention was categorized using International League Against Epilepsy classification.

Dr. Marquez’s group found that 69.2% of patients were completely seizure-free with no auras, 11.5% of patients had one to three seizure days per year with or without auras, and 19.2% of patients had one to four seizure days per year or a 50% seizure reduction per year with or without auras. Favorable seizure outcomes in the clinical setting were defined as having at least a 50% reduction in seizures postoperatively.

“Our experience with standard temporal lobectomy and SAH in the treatment of medically intractable epilepsy has been a favorable one,” said the researchers. “Moreover, the overall seizure burden decreased dramatically at five years postsurgery for all 50 patients who underwent surgical intervention. It remains clear that standard temporal lobectomy or SAH is a safe and well-tolerated primary or adjunctive treatment in the surgical management of epilepsy.”

—Colby Stong

Brivaracetam May Benefit Patients With Poorly Controlled Seizures
Daily doses of 100 mg and 200 mg of brivaracetam are well tolerated and may reduce seizure frequency when administered as adjunctive therapy in adults with refractory epilepsy and partial-onset seizures, according to results from a phase III clinical trial.

“The two primary outcomes in this study evaluating adjunctive brivaracetam in the treatment of partial-onset seizures in adults with epilepsy were statistically significant and clinically relevant,” said Pavel Klein, MD, Director of the Mid-Atlantic Epilepsy and Sleep Center in Bethesda, Maryland.

Dr. Klein and colleagues performed a multicenter, randomized, double-blind, placebo-controlled study. The goal was to analyze the efficacy and safety of brivaracetam, an analog of levetiracetam, in adults with poorly controlled partial-onset seizures.

The researchers administered doses of 100 mg/day or 200 mg/day of brivaracetam as an adjunctive treatment to 764 adults who were taking one or two concurrent antiepileptic drugs (AEDs). More than 80% of participants had failed at least two previous AEDs, and approximately 47% reported failing five or more AEDs. Individuals who had taken levetiracetam within 90 days of study initiation were excluded.

Patients participated in an eight-week baseline period followed by 12 weeks of brivaracetam treatment. After the 12-week treatment period, long-term follow-up was conducted to monitor the drug’s efficacy and safety. Data from seizure diaries indicated a clinically relevant reduction in the frequency of partial-onset seizures during a 28-day period among patients taking either dose of brivaracetam.

Patients taking 100 mg of brivaracetam had a 22.8% reduction in seizure frequency over a 28-day period. This was similar to the 23.2% reduction in seizure frequency observed in patients taking 200 mg of brivaracetam. The findings were consistent regardless of previous levetiracetam exposure.

A total of 23 patients treated with brivaracetam, including 13 (5.4%) taking 100 mg and 10 (4%) taking 200 mg, achieved complete freedom from all seizure types. Two patients in the placebo group achieved seizure freedom.

In general, the treatment was well tolerated. Between 7% and 19% of patients taking 100 mg, and between 8% and 16% of patients taking 200 mg, had adverse events, compared with 3% to 8% of patients in the placebo group. The most common adverse

“Levetiracetam is a great medication that is usually well tolerated, but it has got potential for psychiatric side effects,” said Dr. Klein. Approximately 10% of people receiving levetiracetam have irritability. “The rate of irritability in this study was 2% for both the 100-mg dose and the 200-mg dose, versus 1% for placebo. If brivaracetam turns out to be a more friendly version of levetiracetam, then that would be a helpful thing,” Dr. Klein concluded.

—Erik Greb

SEATTLE—Complex febrile seizures, a family history of febrile seizures, male gender, and early onset of the first febrile seizure may increase the risk of recurrent febrile seizures, according to investigators.

“Abnormal EEG findings and low parental educational status may be new prognostic indicators,” reported Min-su Oh and Seung Hyo Kim from Jeju National University, Republic of Korea. “However, further investigation using larger populations and a prospective design is needed to confirm the validity of these prognostic factors.”

The researchers retrospectively reviewed medical records of 293 patients whose first febrile seizure developed between ages 3 months and 5 years. All subjects had visited the outpatient clinic or were admitted to the pediatric department of the Jeju National University Hospital for a first febrile seizure between March 2007 and May 2013. A recurrent febrile seizure was defined as a febrile seizure that occurred more than twice. Patients who had evidence of intracranial infection or an unprovoked seizure before the first febrile seizure were excluded.

The investigators analyzed variables such as age, gender, birth history, body temperature at onset of first febrile seizure, presence of complex febrile seizure or epilepsy (first-degree relatives), EEG findings, the family’s economic status, and parents’ educational level.

A total of 293 patients (178 boys) were included. Mean follow-up duration since onset of the first febrile seizure was 41.8 months. Mean age was 60.7 months. Average age at the first febrile seizure was 18.9 months. Patients had an average of 3.6 febrile seizure attacks, and family histories of febrile seizures and epilepsy were observed in 82 (28.0%) and 22 (7.5%) patients, respectively. A total of 130 (44.4%) patients had a complex febrile seizure, while 33.8% developed a febrile seizure before age 1; 60.8% had a body temperature less than 39° C at the onset of their first febrile seizure, and 12.6% had neurodevelopmental delay.

Patients were grouped into those who had fewer than three febrile seizures and those who had more than two attacks. “Parameters such as maternal age at childbirth, gestational age, mode of delivery, birth weight, family’s low economic status, and family history of epilepsy did not differ significantly between the groups,” noted the researchers.

EEG was performed in 69.6% of participants. Information about educational status for both parents was collected in 71.3% of subjects. “These two variables were not included in the multivariate model because these numbers were not considered representative of the whole sample,” the investigators explained.

After multivariate analysis was conducted, several parameters yielded statistically significant findings—complex febrile seizures (odds ratio [OR, 3.69),]family history of febrile seizures (OR, 3.10), male gender (OR, 2.44), and early onset of the first febrile seizure (younger than age 1 year; OR, 1.89).

—Colby Stong

Epilepsy Surgery Is Safe and Effective After Five-Year Follow-up
Nearly 70% of patients with medically intractable epilepsy were seizure-free five years after undergoing standard temporal lobectomy or selective amygdalohippocampectomy (SAH), according to Yvette Marquez, MD, from the University of Southern California (USC), and colleagues.

The investigators reviewed data from 131 patients with medically intractable temporal lobe epilepsy who underwent standard temporal lobectomy or SAH between 2004 and 2013 at the Los Angeles County–USC Medical Center and Keck Medical Center. Fifty patients who had follow-up of at least five years were included in the analysis. The rate of seizure cure after surgical intervention was categorized using International League Against Epilepsy classification.

Dr. Marquez’s group found that 69.2% of patients were completely seizure-free with no auras, 11.5% of patients had one to three seizure days per year with or without auras, and 19.2% of patients had one to four seizure days per year or a 50% seizure reduction per year with or without auras. Favorable seizure outcomes in the clinical setting were defined as having at least a 50% reduction in seizures postoperatively.

“Our experience with standard temporal lobectomy and SAH in the treatment of medically intractable epilepsy has been a favorable one,” said the researchers. “Moreover, the overall seizure burden decreased dramatically at five years postsurgery for all 50 patients who underwent surgical intervention. It remains clear that standard temporal lobectomy or SAH is a safe and well-tolerated primary or adjunctive treatment in the surgical management of epilepsy.”

—Colby Stong

Brivaracetam May Benefit Patients With Poorly Controlled Seizures
Daily doses of 100 mg and 200 mg of brivaracetam are well tolerated and may reduce seizure frequency when administered as adjunctive therapy in adults with refractory epilepsy and partial-onset seizures, according to results from a phase III clinical trial.

“The two primary outcomes in this study evaluating adjunctive brivaracetam in the treatment of partial-onset seizures in adults with epilepsy were statistically significant and clinically relevant,” said Pavel Klein, MD, Director of the Mid-Atlantic Epilepsy and Sleep Center in Bethesda, Maryland.

Dr. Klein and colleagues performed a multicenter, randomized, double-blind, placebo-controlled study. The goal was to analyze the efficacy and safety of brivaracetam, an analog of levetiracetam, in adults with poorly controlled partial-onset seizures.

The researchers administered doses of 100 mg/day or 200 mg/day of brivaracetam as an adjunctive treatment to 764 adults who were taking one or two concurrent antiepileptic drugs (AEDs). More than 80% of participants had failed at least two previous AEDs, and approximately 47% reported failing five or more AEDs. Individuals who had taken levetiracetam within 90 days of study initiation were excluded.

Patients participated in an eight-week baseline period followed by 12 weeks of brivaracetam treatment. After the 12-week treatment period, long-term follow-up was conducted to monitor the drug’s efficacy and safety. Data from seizure diaries indicated a clinically relevant reduction in the frequency of partial-onset seizures during a 28-day period among patients taking either dose of brivaracetam.

Patients taking 100 mg of brivaracetam had a 22.8% reduction in seizure frequency over a 28-day period. This was similar to the 23.2% reduction in seizure frequency observed in patients taking 200 mg of brivaracetam. The findings were consistent regardless of previous levetiracetam exposure.

A total of 23 patients treated with brivaracetam, including 13 (5.4%) taking 100 mg and 10 (4%) taking 200 mg, achieved complete freedom from all seizure types. Two patients in the placebo group achieved seizure freedom.

In general, the treatment was well tolerated. Between 7% and 19% of patients taking 100 mg, and between 8% and 16% of patients taking 200 mg, had adverse events, compared with 3% to 8% of patients in the placebo group. The most common adverse

“Levetiracetam is a great medication that is usually well tolerated, but it has got potential for psychiatric side effects,” said Dr. Klein. Approximately 10% of people receiving levetiracetam have irritability. “The rate of irritability in this study was 2% for both the 100-mg dose and the 200-mg dose, versus 1% for placebo. If brivaracetam turns out to be a more friendly version of levetiracetam, then that would be a helpful thing,” Dr. Klein concluded.

—Erik Greb