CLINICAL PREDICTORS OF INEFFECTIVENESS OF INITIAL MONOTHERAPY OF EPILEPSY IN CHILDREN

Actuality. Effectiveness of epilepsy treatment in children is determined by the possibility of achieving clinical remission at initial monotherapy. The spectrum of anticonvulsants recommended for initial treatment of epilepsy in children is relatively known, but the analysis of their prescription indicates the influence of other non-pharmacologic factors on the possibility of achieving adequate control over epileptic seizures. Objective of the study: to find the frequency of achieving clinical remission in children with epilepsy while taking initial anticonvulsant and to define a combination of independent clinical factors which determine ineffectiveness of initial anticonvulsant monotherapy. Material and methods. Using the method of target selection there was performed a cohort retrospective-prospective comparative study of 447 children with epilepsy aged from birth to 17 years old. The frequency of clinical remission at initial anticonvulsant therapy was analyzed; a comparative study of clinical parameters was made within the frames of mono-factor analysis in order to find significant differences with consideration of age of epilepsy onset and effectiveness of initial treatment. Results. The study found the influence of a child's age at epilepsy debut on achieving clinical remission at initial monotherapy: the younger the child, the lower is the possibility of its acheving, pllat<0.001. The highest frequency of absence of remission was noted in children under 1 year (72.5%) and those aged 1-3 years (71.4%) in comparison to children of older age groups (33.0%-59.5%), pFisher<0.001.The factors which define the prognosis of initial treatment of epilepsy in children were determined: in case of chronic somatic comorbidity ineffectiveness of therapy was noted in 69.8% of cases (pFisher<0.001) and chances of remission absence raised by 2.5 times (ОR=2.480; S=0.201; 95% CI [1.672; 3.681]; in case of psychic comorbidity therapy was ineffective in 87.6% of cases (pFisher<0.001) with a 7-fold increase of chances of remission absence (ОR=7.06; S=0.283; 95% CI [4.054; 12.291]; in case of neurologic comorbidity monotherapy was ineffective in 76.3% of cases (pFisher<0.001) and chances of remission absence increased by 3.9 times (ОR=3.925; S=0.206; 95% CI [2.62; 5.88]. For the first time the combination of independent factors in patients with epilepsy was stated – age at disease onset less than 6 years, presence of neurologic disorders, focal or combined types of epilepsy, presence of chronic somatic comorbidity. The set of these factors validly defines prognosis of effectiveness of initial anticonvulsant therapy with precision of 78.5% (AUC = 0.785; 95% CI [0.742; 0.828]) (p<0.001) by the results of ROC-analysis and with precision of 72.5% by the results of logistic regression (0.725 with 95% CI [0.680; 0.765]), which proves the tactics of fast correction of anticonvulsant dosage, its change and using rational polytherapy at initial stage of epilepsy treatment in children. Conclusions. New data regarding prognosis of effectiveness of initial anticonvulsant momotherapy in children were received; they allow defining the possibility of achieving clinical remission at prescribing the first anticonvulsant with a probability of more than 70%.