Clinical and EEG predictors of treatment response in pediatric absence epilepsy - a single-center experience

Abstract

Aim of the study: Absence epilepsy, though primarily affecting children, can also emerge during adolescence or adulthood, showing a wide spectrum of clinical presentations and treatment responses. The aim of this study is to evaluate the clinical and electroencephalographic (EEG) characteristics of absence epilepsy and identify factors that influence treatment outcomes and long-term prognosis.

Clinical rationale for the study: While childhood absence epilepsy (CAE) is often associated with favorable prognosis, a subset of patients experiences drug resistance and persistent seizures. Understanding the clinical and EEG predictors of treatment success or failure can support more effective, individualized therapeutic strategies and improve long-term management.

Material and methods: This prospective study included 57 pediatric patients diagnosed with absence epilepsy. Clinical data and EEG findings were analyzed focusing on age of onset, seizure frequency, EEG patterns, family history, and treatment response. Patients were followed over a 12-month period to assess seizure outcomes and treatment efficacy.

Results: Childhood absence epilepsy was the most common subtype, identified in 73.7 % of cases. A total of 85% of patients achieved seizure remission within six months of initiating treatment. A favorable prognosis was significantly associated with early age of onset, presence of typical 3-4 Hz spike-and-wave discharges on EEG, and rapid response to first-line anti-epileptic drugs (AEDs). In contrast, patients diagnosed with juvenile absence epilepsy (JAE), myoclonic absence seizures, or absence seizures with eyelid myoclonia often required more complex treatment regimens and demonstrated a higher risk of persistent seizures.

Conclusions and clinical implications: Absence epilepsy encompasses a range of clinical syndromes, and outcomes are influenced by seizure type, age at onset, EEG characteristics, and initial treatment response. Early diagnosis and prompt initiation of appropriate therapy are critical for achieving seizure control. However, some patients, particularly those with atypical absence syndromes, may continue to experience therapeutic challenges, highlighting the need for tailored treatment approaches and long-term follow-up.

Keywords: EEG; absence epilepsy; childhood absence epilepsy; juvenile absence epilepsy; seizure.