Pick Topic
Review Topic
List Experts
Examine Expert
Save Expert
  Site Guide ··   
Epilepsy: HELP
Articles by Peter R. Camfield
Based on 41 articles published since 2009
(Why 41 articles?)
||||

Between 2009 and 2019, P. Camfield wrote the following 41 articles about Epilepsy.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Guideline Epilepsy: Transition from pediatric to adult care. Recommendations of the Ontario epilepsy implementation task force. 2017

Andrade, Danielle M / Bassett, Anne S / Bercovici, Eduard / Borlot, Felippe / Bui, Esther / Camfield, Peter / Clozza, Guida Quaglia / Cohen, Eyal / Gofine, Timothy / Graves, Lisa / Greenaway, Jon / Guttman, Beverly / Guttman-Slater, Maya / Hassan, Ayman / Henze, Megan / Kaufman, Miriam / Lawless, Bernard / Lee, Hannah / Lindzon, Lezlee / Lomax, Lysa Boissé / McAndrews, Mary Pat / Menna-Dack, Dolly / Minassian, Berge A / Mulligan, Janice / Nabbout, Rima / Nejm, Tracy / Secco, Mary / Sellers, Laurene / Shapiro, Michelle / Slegr, Marie / Smith, Rosie / Szatmari, Peter / Tao, Leeping / Vogt, Anastasia / Whiting, Sharon / Carter Snead, O. ·Division of Neurology, Epilepsy Transition Program and Epilepsy Genetics Program, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada. · Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada. · Division of Neurology, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada. · Department of Neurology, Clinical Neurosciences Center University of Utah School of Medicine, Salt Lake City, Utah, U.S.A. · Division of Pediatric Neurology, Dalhousie University, Halifax, Nova Scotia, Canada. · Parent Representative, Toronto, Ontario, Canada. · Division of Pediatric Medicine, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada. · Ontario Shores, Whitby, Ontario, Canada. · Family Physician, Sudbury, Ontario, Canada. · Erin Oak Kids, Centre for Treatment and Development, Toronto, Ontario, Canada. · Provincial Council for Maternal and Child Health, Toronto, Ontario, Canada. · Patient Representative, Toronto, Ontario, Canada. · Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada. · Hospital for Sick Children, Toronto, Ontario, Canada. · Division of Adolescent Medicine, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada. · St. Michael's Hospital, Toronto, Ontario, Canada. · Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada. · Epilepsy Program, Toronto Western Hospital, Toronto, Ontario, Canada. · Division of Neurology, Queens University, Kingston General Hospital, Kingston, Ontario, Canada. · Division of Neuropsychology, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada. · LIFEspan Service, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada. · Pediatric Epileptologist, Division of Pediatric Neurology, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada. · Pediatric Neurology, University of Texas Southwestern and Dallas Children's Medical Center, Dallas, Texas, U.S.A. · Pediatric Neurologist, Centre of Reference Epilepsies Rares, Hospital Necker-Enfants Malades, Paris, France. · Parent Representative, London, Ontario, Canada. · Strategic Initiatives, Epilepsy Support Centre, London, Ontario, Canada. · Family Physician, Toronto, Ontario, Canada. · Division of Neurology, McMaster University, Hamilton Health Sciences Centre, Hamilton, Ontario, Canada. · Neurologist, Toronto, Ontario, Canada. · Adult Services, Epilepsy Toronto, Toronto, Ontario, Canada. · Child and Youth Mental Health Collaborative, Centre for Addiction and Mental Health, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. · Surrey Place Centre, Toronto, Ontario, Canada. · Critical Care Services, Toronto, Ontario, Canada. · Division of Pediatric Neurology, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada. · Division of Pediatric Neurology, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada. ·Epilepsia · Pubmed #28681381.

ABSTRACT: The transition from a pediatric to adult health care system is challenging for many youths with epilepsy and their families. Recently, the Ministry of Health and Long-Term Care of the Province of Ontario, Canada, created a transition working group (TWG) to develop recommendations for the transition process for patients with epilepsy in the Province of Ontario. Herein we present an executive summary of this work. The TWG was composed of a multidisciplinary group of pediatric and adult epileptologists, psychiatrists, and family doctors from academia and from the community; neurologists from the community; nurses and social workers from pediatric and adult epilepsy programs; adolescent medicine physician specialists; a team of physicians, nurses, and social workers dedicated to patients with complex care needs; a lawyer; an occupational therapist; representatives from community epilepsy agencies; patients with epilepsy; parents of patients with epilepsy and severe intellectual disability; and project managers. Three main areas were addressed: (1) Diagnosis and Management of Seizures; 2) Mental Health and Psychosocial Needs; and 3) Financial, Community, and Legal Supports. Although there are no systematic studies on the outcomes of transition programs, the impressions of the TWG are as follows. Teenagers at risk of poor transition should be identified early. The care coordination between pediatric and adult neurologists and other specialists should begin before the actual transfer. The transition period is the ideal time to rethink the diagnosis and repeat diagnostic testing where indicated (particularly genetic testing, which now can uncover more etiologies than when patients were initially evaluated many years ago). Some screening tests should be repeated after the move to the adult system. The seven steps proposed herein may facilitate transition, thereby promoting uninterrupted and adequate care for youth with epilepsy leaving the pediatric system.

2 Editorial Synthetic ACTH Is Not Superior to Prednisolone for Infantile Spasms: Randomized Clinical Trials and Tribulations. 2015

Mytinger, John R / Camfield, Peter R. ·Division of Pediatric Neurology, The Ohio State University, Nationwide Children's Hospital, Columbus, Ohio. Electronic address: John.Mytinger@nationwidechildrens.org. · Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada. ·Pediatr Neurol · Pubmed #26302697.

ABSTRACT: -- No abstract --

3 Editorial The outcome of childhood epilepsy: what improvements are needed? 2013

Camfield, Peter / Camfield, Carol / Arts, Willem F / Brouwer, Oebele F / Arzimanoglou, Alexis. · ·Epileptic Disord · Pubmed #23774399.

ABSTRACT: -- No abstract --

4 Editorial Help youth with epilepsy to become competent and happy adults: Transition care. 2013

Camfield, Peter / Camfield, Carol. · ·Seizure · Pubmed #23664022.

ABSTRACT: -- No abstract --

5 Review Regression in children with epilepsy. 2019

Camfield, Peter / Camfield, Carol. ·Department of Pediatrics, Dalhousie University and the IWK Health Centre, Canada. Electronic address: camfield@dal.ca. · Department of Pediatrics, Dalhousie University and the IWK Health Centre, Canada. ·Neurosci Biobehav Rev · Pubmed #30537476.

ABSTRACT: Regression in children with epilepsy may involve loss of cognitive abilities, failure to progress or a slowing of developmental trajectory. A few seizures do not lead to regression. Large numbers of seizures may be associated with regression but the cause is an important cofounder. Individual spike discharges on EEG are associated with transient cognitive impairment and continuous spike discharges with regression. Regression may be global in continuous spike wave in slow sleep (CSWS) or specific (auditory agnosia) in Landau Kleffner syndrome. Regression is mild and transient in Rolandic Epilepsy or profound and permanent in West Syndrome. Epilepsy syndromes grouped under "epileptic encephalopathies" may lead to regression, although proof of this concept is not strong for many syndromes. The absence of cognitive assessment before epilepsy onset, the contribution of the cause and complications of treatment make for difficult methodological problems. The large majority of children with epilepsy do not have regression. There is need for more longitudinal studies of children with epileptic encephalopathies and other epilepsies associated with regression.

6 Review Outcome of childhood-onset epilepsy from adolescence to adulthood: Transition issues. 2017

Nabbout, R / Andrade, D M / Bahi-Buisson, N / Cross, H / Desquerre, I / Dulac, O / Granata, T / Hirsch, E / Navarro, V / Ouss, L / Pearl, P L / Schmidt, D / Thiele, E / Camfield, P R / Camfield, C S. ·Reference Centre for Rare Epilepsies, Pediatric Neurology, Necker-Enfants Malades University Hospital, APHP, University of Paris Descartes, Inserm U1129, Paris, France. Electronic address: rimanabbout@yahoo.com. · Department of Medicine, University of Toronto Adult Epilepsy Genetics Program, University of Toronto, Toronto Western Hospital, Toronto, Canada. · Embryology and Genetics of Congenital Malformations & Pediatric Neurology, Necker Enfants Malades University Hospital, Paris France. · UCL Institute of Child Health, London, UK. · Reference Centre for Rare Epilepsies, Pediatric Neurology, Necker-Enfants Malades University Hospital, APHP, University of Paris Descartes, Inserm U1129, Paris, France. · Department of Pediatric Neuroscience, Foundation I.R.C.C.S. Neurological Institute C. Besta, Milan, Italy. · Service de Neurologie, Hôpital de Hautepierre, Strasbourg, France. · GH Pitie-Salpêtrière-Charles Foix, Epilepsy Unit and Department of Clinical Neurophysiology, Institut du Cerveau et de la Moelle, Paris, France. · Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States. · Epilepsy Research Group, Free University of Berlin, Berlin, Germany. · Director, Pediatric Epilepsy Program and Herscot Center for TSC, Massachusetts General Hospital, Boston, MA, United States. · Dalhousie University, IWK Health Centre, Halifax, Nova Scotia, Canada. ·Epilepsy Behav · Pubmed #28256379.

ABSTRACT: This is the second of three papers that summarize the second symposium on Transition in Epilepsies held in Paris in June 2016. This paper addresses the outcome for some particularly challenging childhood-onset epileptic disorders with the goal of recommending the best approach to transition. We have grouped these disorders in five categories with a few examples for each. The first group includes disorders presenting in childhood that may have late- or adult-onset epilepsy (metabolic and mitochondrial disorders). The second group includes disorders with changing problems in adulthood (tuberous sclerosis complex, Rett syndrome, Dravet syndrome, and autism). A third group includes epilepsies that change with age (Childhood Absence Epilepsy, Juvenile Myoclonic Epilepsy, West Syndrome, and Lennox-Gastaut syndrome). A fourth group consists of epilepsies that vary in symptoms and severity depending on the age of onset (autoimmune encephalitis, Rasmussen's syndrome). A fifth group has epilepsy from structural causes that are less likely to evolve in adulthood. Finally we have included a discussion about the risk of later adulthood cerebrovascular disease and dementia following childhood-onset epilepsy. A detailed knowledge of each of these disorders should assist the process of transition to be certain that attention is paid to the most important age-related symptoms and concerns.

7 Review Understanding Death in Children With Epilepsy. 2017

Donner, Elizabeth J / Camfield, Peter / Brooks, Linda / Buchhalter, Jeffrey / Camfield, Carol / Loddenkemper, Tobias / Wirrell, Elaine. ·Division of Neurology, Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada. Electronic address: elizabeth.donner@sickkids.ca. · Department of Pediatrics, Dalhousie University and the IWK Health Centre, Halifax, NS, Canada. · The SUDEP Institute, Epilepsy Foundation, Landover, Maryland. · Department of Paediatrics, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Clinical Neuroscience, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. · Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts. · Mayo Clinic, Rochester, Minnesota. ·Pediatr Neurol · Pubmed #28242084.

ABSTRACT: Death in children with epilepsy is profoundly disturbing, with lasting effects on the family, community, and health care providers. The overall risk of death for children with epilepsy is about ten times that of the general population. However, the risk of premature death for children without associated neurological comorbidities is similar to that of the general population, and most deaths are related to the cause of the epilepsy or associated neurological disability, not seizures. The most common cause of seizure-related death in children with epilepsy is sudden unexpected death in epilepsy (SUDEP). SUDEP is relatively uncommon in childhood, but the risk increases if epilepsy persists into adulthood. Although the direct cause of SUDEP remains unknown, most often death follows a generalized convulsive seizure and the risk of SUDEP is strongly related to drug-resistant epilepsy and frequent generalized tonic-clonic seizures. The most effective SUDEP prevention strategy is to reduce the frequency of seizures, although a number of seizure detection devices are under development and in the future may prove to be useful for seizure detection for those at particularly high risk. There are distinct benefits for health care professionals to discuss mortality with the family soon after the diagnosis of epilepsy. An individual approach is appropriate. When a child with epilepsy dies, particularly if the death was unexpected, family grief may be profound. Physicians and other health care professionals have a critical role in supporting families that lose a child to epilepsy. This review will provide health care providers with information needed to discuss the risk of death in children with epilepsy and support families following a loss.

8 Review Treatment issues for children with epilepsy transitioning to adult care. 2017

Nabbout, Rima / Camfield, Carol S / Andrade, Danielle M / Arzimanoglou, Alexis / Chiron, Catherine / Cramer, Joyce A / French, Jacqueline A / Kossoff, Eric / Mula, Marco / Camfield, Peter R. ·Reference Centre for Rare Epilepsies, Pediatric Neurology, Necker-Enfants Malades Hospital, APHP, University of Paris Descartes, Inserm U1129, Paris, France. Electronic address: rimanabbout@yahoo.com. · Dalhousie University & IWK Health Center, Dalhousie University, Halifax, Nova Scotia, Canada. · Department of Medicine, University of Toronto Adult Epilepsy Genetics Program, University of Toronto, Toronto Western Hospital, Toronto, Canada. · University Hospitals of Lyon (HCL) and DYCOG Team, Lyon Neuroscience Research Centre (CRNL), INSERM U1028, CNRS UMR 5292, Lyon, France. · Pediatric Neurology, Necker-Enfants Malades Hospital, Inserm U1129, Paris, France. · Yale University School of Medicine, New Haven, CT, USA. · NYU Comprehensive Epilepsy Center, New York, NY, United States. · Johns Hopkins University, Baltimore, MD, United States. · Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, Department of Neuropsychiatry, South West London & St George's Mental Health Trust, Institute of Medical and Biomedical Sciences, St George's University of London, United Kingdom. · Dalhousie University & IWK Health Center, Dalhousie University, Halifax, NS, Canada. ·Epilepsy Behav · Pubmed #28188045.

ABSTRACT: This is the third of three papers that summarize the second symposium on Transition in Epilepsies held in Paris in June 2016. This paper focuses on treatment issues that arise during the course of childhood epilepsy and make the process of transition to adult care more complicated. Some AEDs used during childhood, such as stiripentol, vigabatrin, and cannabidiol, are unfamiliar to adult epilepsy specialists. In addition, new drugs are being developed for treatment of specific childhood onset epilepsy syndromes and have no indication yet for adults. The ketogenic diet may be effective during childhood but is difficult to continue in adult care. Regional adult epilepsy diet clinics could be helpful. Polytherapy is common for patients transitioning to adult care. Although these complex AED regimes are difficult, they are often possible to simplify. AEDs used in childhood may need to be reconsidered in adulthood. Rescue medications to stop prolonged seizures and clusters of seizures are in wide home use in children and can be continued in adulthood. Adherence/compliance is notoriously difficult for adolescents, but there are simple clinical approaches that should be helpful. Mental health issues including depression and anxiety are not always diagnosed and treated in children and young adults even though effective treatments are available. Attention deficit hyperactivity disorder and aggressive behavior disorders may interfere with transition and successful adulthood but these can be treated. For the majority, the adult social outcome of children with epilepsy is unsatisfactory with few proven interventions. The interface between pediatric and adult care for children with epilepsy is becoming increasingly complicated with a need for more comprehensive transition programs and adult epileptologists who are knowledgeable about special treatments that benefit this group of patients.

9 Review The transition from pediatric to adult care for youth with epilepsy: Basic biological, sociological, and psychological issues. 2017

Camfield, Peter / Camfield, Carol / Busiah, Kanetee / Cohen, David / Pack, Alison / Nabbout, Rima. ·Dalhousie University and IWK Health Centre, Halifax, Nova Scotia, Canada; Pediatric Department, Dalhousie University and IWK Health Centre, Halifax, Nova Scotia, Canada. Electronic address: camfield@dal.ca. · Dalhousie University and IWK Health Centre, Halifax, Nova Scotia, Canada; Pediatric Department, Dalhousie University and IWK Health Centre, Halifax, Nova Scotia, Canada. · Trousseau Hospital and Necker-Enfants Malades Hospital, APHP, Paris, France. · Université Pierre et Marie Curie and Pitié-Salpétrière, Paris, France. · Columbia University Medical Center, New York, NY, United States. · Reference centre for rare epilepsies, Pediatric Neurology, Necker-Enfants Malades University Hospital, APHP, University of Paris Descartes, Inserm U1129, Paris, France. ·Epilepsy Behav · Pubmed #28089368.

ABSTRACT: Transition from pediatric to adult health care for adolescents with epilepsy is challenging for the patient, family, and health care workers. This paper is the first of three that summarize the main findings from the 2nd Symposium on Transition in Epilepsies, held in Paris from June 14-25, 2016. In this paper we describe five basic themes that have an important effect on transition. First, there are important brain changes in adolescence that leave an imbalance between risk taking and pleasure seeking behaviors and frontal executive function compared with adults. Second, puberty is a major change during the transition age. The three most important but separate neuroendocrine axes involved in puberty are gonadarche (activation of the gonads), adrenarche (activation of adrenal androgen production), and activation of the growth hormone-insulin like growth factor. Third, sexual debut occurs during the transition years, and at an earlier age in adolescents with epilepsy than controls. Adult sexual performance is often unsatisfactory. Although AED-induced alterations in sexual hormones and temporal lobe epilepsy may play a role in hyposexuality, depression, anxiety, and other social factors appear most important. Fourth, psychological development is very important with an evolution from an early stage (ages 10-13years) with concrete thinking, to a middle stage (ages 14-17) with analytic and more abstract introspective thinking, and then to a late stage (ages 18-21) with at least the beginnings of adult reasoning. Epilepsy may derail this relatively orderly progression. Adolescents with autistic spectrum disorder may present with severe behavior problems that are sometimes related to undiagnosed epilepsy. Fifth, bone health in adolescence is critical to establish adequate mineralization for all of adult life. While AED interference with Vitamin D metabolism is important, there is evidence that the effects of AEDs on bone are more complex and involve changes in remodeling. Hence, some non-inducing AEDs may have a significant effect on bone health. All five of these themes lead to recommendations for how to approach adolescents and young adults during transition and some specific interventions to achieve maximum long-term adult independence and quality of life.

10 Review Helping Families Cope with the Severe Stress of Dravet Syndrome. 2016

Camfield, Peter / Camfield, Carol / Nolan, Kathleen. ·1Department of Paediatrics,Dalhousie University,Halifax,Nova Scotia,Canada. · 3Department of Paediatrics,McMaster University,Hamilton,Ontario,Canada. ·Can J Neurol Sci · Pubmed #27264140.

ABSTRACT: A child with Dravet syndrome shakes family life to the core. Dravet syndrome usually has three phases: (1) up to 1-1½ years: with episodes of febrile status epilepticus but normal development; (2) age 1½ to ~6-10 years: with frequent seizures of varying types, developmental stagnation, behavioural and sleep problems; (3) after ~10 years: improvement in seizures, deteriorating gait, intellectual disability but some developmental gains. Complete seizure control is rare-simply prescribing medication is inadequate to help families. Based on structured interviews with 24 families and confirmed by more informal discussions with other families, we suggest strategies for coping with this catastrophe. A child with Dravet syndrome usually means that one parent cannot work-financial pressures should be anticipated. In Stage 1, the approach to status should include a written protocol. An indwelling catheter for rapid venous access may be helpful. In Stage 2, assistance finding qualified babysitters is required, and the extended family needs encouragement to help. Appropriate equipment, rescue medication and protocols should travel with the child. Siblings may benefit from a system of one parent "on call." An internet support group provides an invaluable lifeline. In Stage 3, family isolation may be extreme-respite care and personal time for parents are important. Death from status, accidents and SUDEP (sudden unexplained death in epilepsy) occurs in 15%. Fear of SUDEP needs to be addressed. Moving from paediatric to adult care is frightening; an epilepsy transition clinic is useful. Attention to these realities may improve the quality of life for both child and family.

11 Review Delivery of epilepsy care to adults with intellectual and developmental disabilities. 2015

Devinsky, Orrin / Asato, Miya / Camfield, Peter / Geller, Eric / Kanner, Andres M / Keller, Seth / Kerr, Michael / Kossoff, Eric H / Lau, Heather / Kothare, Sanjeev / Singh, Baldev K / Wirrell, Elaine. ·From New York University School of Medicine (O.D., H.L., S.K.), New York · Children's Hospital of Pittsburgh of UPMC (M.A.), PA · IWK Heath Centre and Dalhousie University (P.C.), Halifax, Canada · Saint Barnabas Medical Center (E.G.), Livingston, NJ · University of Miami Miller School of Medicine (A.M.K.), FL · Advocare Neurology of South Jersey (S.K.), Lumberton, NJ · Welsh Centre for Learning Disabilities (M.K.), Cardiff University, Cathays, Cardiff, UK · Johns Hopkins Hospital (E.H.K.), Baltimore, MD · New York Medical College (B.K.S.), New York · and Mayo Clinic Hospital (E.W.), Rochester, MN. ·Neurology · Pubmed #26423430.

ABSTRACT: Epilepsy is common in people with intellectual and developmental disabilities (IDD). In adulthood, patients with IDD and epilepsy (IDD-E) have neurologic, psychiatric, medical, and social challenges compounded by fragmented and limited care. With increasing neurologic disability, there is a higher frequency of epilepsy, especially symptomatic generalized and treatment-resistant epilepsies. The causes of IDD-E are increasingly recognized to be genetic based on chromosomal microarray analysis to identify copy number variants, gene panels (epilepsy, autism spectrum disorder, intellectual disability), and whole-exome sequencing. A specific genetic diagnosis may guide care by pointing to comorbid disorders and best therapy. Therapy to control seizures should be individualized, with drug selection based on seizure types, epilepsy syndrome, concomitant medications, and comorbid disorders. There are limited comparative antiepileptic drug data in the IDD-E population. Vagus nerve and responsive neural stimulation therapies and resective surgery should be considered. Among the many comorbid disorders that affect patients with IDD-E, psychiatric and sleep disorders are common but often unrecognized and typically not treated. Transition from holistic and coordinated pediatric to adult care is often a vulnerable period. Communication among adult health care providers is complex but essential to ensure best care when these patients are seen in outpatient, emergency room, and inpatient settings. We propose specific recommendations for minimum care standards for people with IDD-E.

12 Review Febrile seizures and genetic epilepsy with febrile seizures plus (GEFS+). 2015

Camfield, Peter / Camfield, Carol. ·Department of Pediatrics, Dalhousie University and the IWK Health Centre, Halifax, Nova Scotia, Canada. ·Epileptic Disord · Pubmed #25917466.

ABSTRACT: To review the literature about febrile seizures and GEFS plus with special emphasis on management and outcome. Selected literature review. Febrile seizures are the most common convulsive event in humans, occurring in 2-6% of the population. The aetiology is complex with strong evidence for a heterogeneous genetic predisposition interacting with fever of any cause, with certain viral infections having a greater effect. A large amount of literature has established that febrile seizures have no long-term consequences on cognition or behaviour. Unfortunately, about 40% of children with a first febrile seizure will have a recurrence. The strongest predictor of recurrence is age <14-16 months at the time of the first febrile seizure. Epilepsy follows febrile seizures in ∼3% cases, with the concepts of simple and complex febrile seizures providing relatively weak prediction. Very prolonged febrile seizures may lead to mesial temporal sclerosis and temporal lobe epilepsy although the degree of risk remains uncertain. Investigations beyond establishing the cause of the provoking fever are nearly always unnecessary. Treatment is mainly reassurance and there is some evidence that parents eventually "come to grips" with the fear that their children are dying during a febrile seizure. Antipyretic medications are remarkably ineffective to prevent recurrences. Daily and intermittent prophylactic medications are ineffective or have unacceptable side effects or risks. "Rescue" benzodiazepines may prevent prolonged recurrences for selected patients with a first prolonged febrile seizure although this has not been proven. Genetic epilepsy with febrile seizures plus (GEFS+) is a complex autosomal dominant disorder usually caused by mutations in SCN1A (a voltage-gated sodium channel). One third of patients have febrile seizures only; two thirds have a variety of epilepsy syndromes, both focal and generalized. Febrile seizures may distress parents but rarely have any long-term consequences. Reassurance is the only treatment for the vast majority. Identifying patients with GEFS plus may lead to further investigations and counselling.

13 Review Incidence, prevalence and aetiology of seizures and epilepsy in children. 2015

Camfield, Peter / Camfield, Carol. ·Dalhousie University and IWK Health Centre, Department of Pediatrics, Halifax, Nova Scotia, Canada. ·Epileptic Disord · Pubmed #25895502.

ABSTRACT: AIM: To (1) summarize published, peer-reviewed literature about the incidence and prevalence of epilepsy in children from developed and developing countries around the world, and (2) discuss problems in defining aetiologies of epilepsy in children, and distinguish between seizures and epilepsy. METHODS: Review of selected literature with particular attention to systematic reviews. RESULTS: The incidence of epilepsy in children ranges from 41-187/100,000. Higher incidence is reported from underdeveloped countries, particularly from rural areas. The incidence is consistently reported to be highest in the first year of life and declines to adult levels by the end of the first decade. The prevalence of epilepsy in children is consistently higher than the incidence and ranges from 3.2-5.5/1,000 in developed countries and 3.6-44/1,000 in underdeveloped countries. Prevalence also seems highest in rural areas. The incidence and prevalence of specific seizure types and epilepsy syndromes is less well documented. In population-based studies, there is a slight, but consistent, predominance of focal seizures compared with generalized seizures. Only about one third of children with epilepsy can be assigned to a specific epilepsy syndrome, as defined by the most recently proposed system for organization of epilepsy syndromes. CONCLUSIONS: The incidence and prevalence of epilepsy in children appears to be lower in developed countries and highest in rural areas of underdeveloped countries. The reasons for these trends are not well established. Although focal seizures predominate, the incidence and prevalence of specific epilepsy syndromes is not well documented.

14 Review Bringing the transition of epilepsy care from children to adults out of the shadows. 2014

Nabbout, Rima / Camfield, Peter. ·Pediatric Neurology Department, Reference Center for Rare Epilepsies, Hospital Necker - Enfants Malades, Paris, France. ·Epilepsia · Pubmed #25209088.

ABSTRACT: -- No abstract --

15 Review Transition: driving and exercise. 2014

Nashef, Lina / Capovilla, Giuseppe / Camfield, Carol / Camfield, Peter / Nabbout, Rima. ·Department of Neuroscience, King's College Hospital, London, United Kingdom. ·Epilepsia · Pubmed #25209086.

ABSTRACT: There are many social aspects to consider at the time of transition of adolescents with epilepsy. The role of both pediatric and adult health care providers includes education and guidance within the larger framework of family, society, and country. This section focuses on driving and exercise considerations for those undergoing transition.

16 Review Transition issues for children with diffuse cortical malformations, multifocal postnatal lesions, (infectious and traumatic) and Lennox-Gastaut and similar syndromes. 2014

Camfield, Peter R / Bahi-Buisson, Nadia / Trinka, Eugen. ·Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada. ·Epilepsia · Pubmed #25209082.

ABSTRACT: Patients with epilepsy may have diffuse, serious brain disorders including genetically determined, multilobar malformations, traumatic brain injury, encephalitis and meningitis, and the many causes of Lennox-Gastaut syndrome. Transition to adult care needs to consider concomitant intellectual disability, refractory epilepsy, underlying cause, and other nonneurologic but significant problems, especially for genetic etiologies. Adult epilepsy care coupled with dedicated primary/family care is essential. A multidisciplinary setting may be optimal to address the many issues of clinical care, decision making, custody, and ongoing supervision.

17 Review Epidemiologic aspects: lost in transition. 2014

Beghi, Ettore / Camfield, Peter R / Camfield, Carol S. ·Department of Neuroscience, IRCCS Institute for Pharmacological Research "Mario Negri", Milan, Italy. ·Epilepsia · Pubmed #25209077.

ABSTRACT: Population-based studies focusing on the long-term prognosis of childhood-onset epilepsy show that despite seizure remission in 70-80% of cases, cognitive, behavioral and psychosocial complications are common and will require management and monitoring in adulthood. This type of study design also demonstrates that death is rare in children who are intellectually and neurologically normal and followed for many years, which is the same for the general population. Only those children with neurologic problems sufficiently severe to interfere with activities of daily living have an increased risk of death in childhood. Investigation of potentially remediable complications is paramount, and the use of antiepileptic medications with potential adverse cognitive and behavioral effects should be identified and eliminated or reduced. In addition, education of the family should be improved. As well, identification and control of social and psychiatric complications is necessary and implies a comprehensive management of the patient before and after the transition from childhood into adulthood.

18 Review Does gender influence susceptibility and consequences of acquired epilepsies? 2014

Perucca, Piero / Camfield, Peter / Camfield, Carol. ·Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia; Department of Neurology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia; Murdoch Childrens Research Institute, Melbourne, Victoria, Australia. Electronic address: piero.perucca@mh.org.au. · Department of Pediatrics, Dalhousie University and IWK Health Centre, Halifax, Nova Scotia, Canada. ·Neurobiol Dis · Pubmed #24874544.

ABSTRACT: Gender differences in the incidence and clinical course of acquired and "cryptogenic" epilepsy are reviewed based on a literature search. We emphasized incidence and population-based studies because they are best suited to assess the effect of gender on susceptibility and clinical evolution of these epilepsies and may control for potential confounding factors. However, such studies were only available for a few acquired etiologies. These included tumor, prenatal and perinatal brain insults, cerebrovascular disease, infection, trauma, neurodegenerative disease, and autoimmune disorders. None of these acquired causes has been consistently shown to affect women or men to a greater or lesser degree, although some of the literature is contradictory or inadequate. There is almost no literature that addresses the effect of gender on the clinical course of epilepsy associated with these acquired causes. In addition, most studies of acquired causes do not take into account the incidence of the cause in the population with or without associated epilepsy. In children, "cryptogenic" epilepsy (non-syndromic and without causative MRI lesion) does not appear to have a gender preference and gender does not seem to affect the likelihood of remission. As further population-based studies of the etiology and clinical course of epilepsy are undertaken, it may be worthwhile to more specifically define the role of gender.

19 Review What happens to children with epilepsy when they become adults? Some facts and opinions. 2014

Camfield, Peter R / Camfield, Carol S. ·Department of Pediatrics, Dalhousie University and the IWK Health Centre, Halifax, Nova Scotia, Canada. Electronic address: camfield@dal.ca. · Department of Pediatrics, Dalhousie University and the IWK Health Centre, Halifax, Nova Scotia, Canada. ·Pediatr Neurol · Pubmed #24830766.

ABSTRACT: BACKGROUND: The adult outcome after childhood onset epilepsy is a complex subject because seizure types and severity are diverse, comorbidities are common, and additional factors influence social outcome. We review selected data about seizure remission or persistence and social outcome in adulthood. METHODS: Information came from published literature, especially population-based studies. RESULTS: In general, approximately 50-60% of children with epilepsy eventually have complete seizure remission (i.e., seizure free and off antiepileptic drug treatment): with longer follow-up, the remission rate improves. Predicting remission, persistent or intractable epilepsy is often inaccurate for an individual patient. A tiny proportion of children with epilepsy die as the result of seizures or sudden unexpected death in epilepsy patients; however, an otherwise normal child has the same risk of death as the reference population. When uncontrolled epilepsy persists into adulthood, the rate of sudden unexpected death in epilepsy patients possibly increases. Reports about social outcome in adulthood are increasing. For those with intellectual disability, a lifetime of dependency is to be expected. For those with normal intelligence, adult life is often unsatisfactory with high rates of incomplete education, unemployment, poverty, social isolation, inadvertent pregnancy, and psychiatric disorders. Seizure remission does not ensure good adult social outcome. CONCLUSIONS: Although seizure control in childhood is important, anticipating poor social outcome in adulthood may allow earlier interventions. A well-orchestrated transition from pediatric to adult health care may be beneficial for the 40-50% with persistent seizures and for the majority who are at risk for adult social difficulties.

20 Review Lifetime prognosis of juvenile myoclonic epilepsy. 2013

Baykan, Betul / Martínez-Juárez, Iris E / Altindag, Ebru A / Camfield, Carol S / Camfield, Peter R. ·Istanbul University Epilepsy Center and Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey. baykanb@istanbul.edu.tr ·Epilepsy Behav · Pubmed #23756474.

ABSTRACT: Juvenile myoclonic epilepsy (JME) is among the most common types of genetic epilepsies, displaying a good prognosis when treated with appropriate drugs, but with a well-known tendency to relapse after withdrawal. The majority of patients with JME have continuing seizures after a follow-up of two decades. However, 17% are able to discontinue medication and remain seizure-free thereafter. Clinicians should remember that there is a small but still considerable subgroup of JME patients whose seizures are difficult to treat before informing patients with newly-diagnosed JME about their "benign" prognosis. This resistant course is not fully explained, though there are many suggested factors. The dominating myoclonic seizures disappear or diminish in severity in the fourth decade of life. Despite the favorable seizure outcome in most of the cases, 3/4 of patients with JME have at least one major unfavorable social outcome. The possible subsyndromes of JME, its genetic background, and its pathophysiological and neuroimaging correlates should be further investigated.

21 Review Epidemiology of juvenile myoclonic epilepsy. 2013

Camfield, Carol S / Striano, Pasquale / Camfield, Peter R. ·Dalhousie University and IWK Health Care Centre, Halifax, Nova Scotia, Canada. camfield@dal.ca ·Epilepsy Behav · Pubmed #23756473.

ABSTRACT: Juvenile myoclonic epilepsy (JME) is a widely recognized presumed genetic, electroclinical idiopathic generalized epilepsy syndrome. The prevalence of JME in large cohorts has been estimated to be 5% to 10% of all epilepsies and around 18% of idiopathic generalized epilepsies but may be lower in some settings. There is a marked female predominance. However, some of the basic epidemiology of JME is not well known, possibly because the syndrome is not sharply defined. A questionnaire study about the diagnostic criteria for JME suggests that diagnosis of JME can be made with the history of myoclonus plus a single generalized tonic-clonic seizure plus generalized fast spike-waves or polyspike-waves on the EEG. However, until these diagnostic criteria are fully accepted, the detailed epidemiology of JME will remain imprecise.

22 Review Helping families cope with the devastation of Dravet syndrome. 2012

Camfield, Peter / Camfield, Carol / Nolan, Kathleen. ·Department of Paediatrics, Dalhousie University and the IWK Health Centre, Halifax, Nova Scotia, Canada. Camfield@dal.ca ·Eur J Paediatr Neurol · Pubmed #22695036.

ABSTRACT: Dravet syndrome shakes family life to the core. Seizure control is rarely complete, and simply prescribing medication is inadequate to help families. Our suggestions are based on structured interviews with >25 Dravet families. In Stage 1 (up to 1-1½ years), a written protocol for an organized approach to status epilepticus is mandatory. In Stage 2 (age from 1½ to ~6-10 years), assistance in finding qualified baby sitters (extended family and others) is required. Equipment, rescue medication and protocols should accompany the child. Siblings may benefit from assigning one parent to be "on call", and an Internet support group provides an invaluable lifeline. In Stage 3 (after ~10 years), family isolation may become extreme: respite care and personal time for parents are important. An epilepsy transition clinic that can effectively liaise with adult emergency services is optimal. Attention to these realities may improve the quality of life for the child and family.

23 Article Cognitive Disabilities and Long-term Outcomes in Children with Epilepsy: A Tangled Tail. 2017

Camfield, Carol / Camfield, Peter. ·Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada. Electronic address: Camfield@dal.ca. · Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada. ·Semin Pediatr Neurol · Pubmed #29249504.

ABSTRACT: Cognitive problems ranging from mild specific learning problems to profound intellectual disability (ID) are very common in children with epilepsy. For most affected patients there is good evidence that the cognitive problems are present at the onset of seizures and do not deteriorate over time. There is no evidence that a few seizures lead to cognitive deterioration. An exception may occur in children with epileptic encephalopathies, although this contention is not always easy to prove. ID is a strong predictor of intractable epilepsy, and the greater the degree of the ID the greater the risk of medication resistant epilepsy. It is not known if specific learning disorders are associated with more severe epilepsy. Rolandic epilepsy is unusual because possibly one-third of patients have transient cognitive and behavioral difficulties during the active phase but later have normal adult social outcome. More longitudinal studies with baseline and repeated cognitive assessments are needed to fully understand the relationship of cognitive problems to childhood onset epilepsy.

24 Article Intractable seizures after a lengthy remission in childhood-onset epilepsy. 2017

Camfield, Peter R / Camfield, Carol S. ·Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada. ·Epilepsia · Pubmed #28983902.

ABSTRACT: OBJECTIVES: To establish the risk of subsequent intractable epilepsy after ≥2, ≥5, and ≥10 years of remission in childhood-onset epilepsy. METHODS: From the Nova Scotia childhood-onset epilepsy population-based cohort patients with all types of epilepsy were selected with ≥20 years follow-up from seizure onset (incidence cases). Children with childhood absence epilepsy were excluded. The rate of subsequent intractable epilepsy was then studied for patients with ≥5 years remission on or off AED treatment and compared with the rate for those with ≥2 and ≥10 years of remission. RESULTS: Three hundred eighty-eight eligible patients had ≥20 years follow-up (average 27.7 ± (standard deviation) 4 years) until they were an average of 34 ± 6.5 years of age. Overall, 297 (77%) had a period of ≥5 years of seizure freedom (average 21.2 ± 8 years), with 90% of these remissions continuing to the end of follow-up. Seizures recurred in 31 (10%) and were intractable in 7 (2%). For the 332 with a remission of ≥2 years seizure-free, 6.9% subsequently developed intractable epilepsy (p = 0.001). For the 260 with ≥10 years remission, 0.78% subsequently developed intractable epilepsy (p = 0.25 compared with ≥5 years remission). SIGNIFICANCE: Even after ≥5 or ≥10 years of seizure freedom, childhood-onset epilepsy may reappear and be intractable. The risk is fortunately small, but for most patients it is not possible to guarantee a permanent remission.

25 Article Poor versus rich children with epilepsy have the same clinical course and remission rates but a less favorable social outcome: A population-based study with 25 years of follow-up. 2016

Camfield, Carol / Camfield, Peter / Smith, Bruce. ·Department of Pediatrics, Dalhousie University and the IWK Health Centre, Halifax, Nova Scotia, Canada. · Department of Mathematics and Statistics, Dalhousie University, Halifax, Nova Scotia, Canada. ·Epilepsia · Pubmed #27813062.

ABSTRACT: OBJECTIVE: To explore the influence of several estimates of family socioeconomic status on the long-term clinical course and social outcomes of children with epilepsy. METHODS: The Nova Scotia childhood epilepsy cohort is population based and includes all children in this Canadian province who developed epilepsy between 1977 and 1985. Eligible patients had ≥10 years of follow-up. Children with childhood absence epilepsy were excluded. Total family income at seizure onset was assessed at seizure onset and classified as "poor" (first quintile), "adequate" (second to third quintiles), and "well-off" (fourth to fifth quintiles). We also assessed parental education and home ownership. Social outcome was assessed in those with normal intelligence who were ≥18 years of age at the end of follow-up using a semistructured interview that explored eight adverse effects. RESULTS: Of 584 patients, 421 (72%) were included. Average follow-up was 26 ± 5.6 years. Overall 137 families (33%) had "poor" income, 159 (38%) had "adequate income," and 125 (30%) were "well-off." Terminal remission of epilepsy occurred in 65% of the poor, 61% of the adequate, and 61% of the well-off (p = ns). Intractable epilepsy, status epilepticus, number of antiepileptic drugs (AEDs) used, and the number of generalized tonic-clonic or focal with secondary generalization seizures through the clinical course was the same in all groups. Home ownership did not predict remission. Neither paternal nor maternal education was associated with remission. Poor children had significantly more adverse social outcomes including failure to graduate from high school, unemployment, personal poverty, inadvertent pregnancy, and psychiatric diagnoses. SIGNIFICANCE: In Nova Scotia with universal health care, coming from a poor or more affluent family does not seem to affect the clinical course or long-term seizure outcome of childhood epilepsy. Unfortunately children from poor families are less likely to have a good social outcome.

Next