Introduction Epilepsy (EP) is one of the entities that are developing in children withperinatal brain lesions (PBL). An early and accurate diagnosis of EP is important because EP has major socioeconomic consequences for both the individual patient and society.
The purpose of the study:we aimed toelucidate the significance of perinatal brain damage in childhood epilepsy.
Research methodology we performed a longitudinal prospective case-control study of 1036 children with PBL withvarious degrees of severity, followedbetween the age of 1–3 months and 48±12 months. Two hundred and fifty-ninechildren from study group (25%; 95CI23,65–26,35)developed EP. The control group included 334 healthy children. EEG examination and MRI brain imaging was performed. Enzyme-linked Immunosorbent Assay (ELISA) was used to assess the concentrations of brain derived neurotrophic factor (BDNF) and ciliary neurotrophic factor (CNTF) in the serum in all children. Statistical analyses were obtained using Statistics 7.0 software (StatSoftInc) and Excel.
Results: Of all cases of EP- 211 (81,47%; 95 CI 79,06–83,88) were generalised forms; 48 (18,5±2,41%; 95CI16,09–20,91)– focalforms. In 89 cases (34,4%; 95CI31,45–37,35) neonatal seizures preceded EP, in the rest 234 cases (90.3% 95 CI 88.47 to 92.13) EP started at infant age, preferentially between 3 and 6 months – 89 (34,4%; 95CI31,45–37,35). We obtained strong correlations between imaging examinations andpharmacoresistant EP (rxy=-0,72)and middle correlations (rxy=-0,53) with controlled EP. EEG changes comprised approximately 9–11 types of routes and have correlated with the type of seizures (rxy=-0,72). Some patterns (isolated slow activity, diffuse slow activity, grouped generalised peaks) werepreceding the epileptiformchanges(rxy=-0,42).The observedcorrelations between low absoluteserum levels of neurotrophic factors(NF) (at 1–3 months) and EEG changes: BDNF (rxy=-0,72) andCNTF (rxy=-0,74), suggestthe development of pharmacoresistant EP and its progress to epileptic encephalopathies with sever neurophysiological processes disturbance.
Conclusions PBL has an important role in child EP. EP is associated withstructural brain abnormalities, variable electroencephalographic changes that strongly correlate with NF deficit, suggesting a reserved prognosis and evolution towards epileptic encephalopathies. NF study allowed the understanding of the pathogeneticaspects of EP, thus forming the basis for the potential neuroprotective strategies and the need for future studies.
- perinatal brain lesions
- neurotrophic factors
- brain derived neurotrophic factor
- ciliary neurotrophic factor
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