First‐ever convulsive seizures in children presenting to the emergency department: risk factors for seizure recurrence and diagnosis of epilepsy

Sartori, Stefano; Nosadini, Margherita; Tessarin, Giulio; Boniver, Clementina; Frigo, Anna Chiara; Toldo, Irene; Bressan, Silvia; Dalt, Liviana Da

doi:10.1111/dmcn.14015

Cited by 35 publications

(35 citation statements)

References 44 publications

(120 reference statements)

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“…8 Children who have had one epileptic seizure have a high risk of recurrent epileptic seizures and epilepsy. 9,10 Despite distinctive pathophysiological features, distinguishing syncope from epileptic seizures may be difficult because non-epileptic disorders can have a similar history or clinical presentation to epilepsy. 11e16 The head-up tilt test (HUTT) may help to distinguish epilepsy from simple or convulsive syncope in a subset of patients.…”

Section: Introductionmentioning

confidence: 99%

Children with transient loss of consciousness: Clinical characteristics and the effectiveness of diagnostic tests

Choi

Han

Lee

2020

Pediatrics & Neonatology

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Background: Transient loss of consciousness (TLOC) is common among children and adolescents. The aims of this study were to identify clinical differences between patients with vasovagal syncope and those with epileptic seizures, which account for a large proportion of TLOC cases, and to evaluate the effectiveness of various diagnostic tests. Methods: The medical records of 160 children and adolescents with TLOC were analyzed retrospectively, and age, sex, clinical symptoms, and trigger factors were recorded. The cardiological and neurological evaluations performed included electrocardiograms, computed tomography scanning, magnetic resonance imaging, electroencephalograms (EEGs), echocardiograms, and head-up tilt tests (HUTTs). Overall assessments of the 160 patients generated final diagnoses. Results: The mean age of patients was 14.6 years old and TLOC occurred more frequently among girls (59.4%). The most common final diagnosis was vasovagal syncope (n Z 102, 63.4%), followed by undetermined (n Z 21, 13.1%) and epileptic seizures (n Z 17, 10.6%). There were many other diagnoses, including cardiogenic syncope (1.3%). Patients diagnosed with vasovagal syncope were much more likely to have dizziness or light-headedness and blurred vision as pre-symptoms (p < 0.05), whereas patients diagnosed with epileptic seizures were more likely to have convulsions as an accompanying sign (p < 0.05). In addition, standing up was the most significant trigger factor for TLOC among those diagnosed with vasovagal syncope (p < 0.05). The sensitivity, specificity, and accuracy of the HUTT for vasovagal syncope were 95.1%, 75.0%, and 91.8%, respectively. Similarly, the sensitivity, specificity, and accuracy of EEGs for epileptic seizures were 80.0%, 70.6%, and 80.0%, respectively. Conclusion: Vasovagal syncope and epileptic seizures should be considered as possible causes of most cases of TLOC in children and adolescents. An accurate case history and appropriate evaluation are essential for correct diagnoses.

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Section: Introductionmentioning

confidence: 99%

Children with transient loss of consciousness: Clinical characteristics and the effectiveness of diagnostic tests

Choi

Han

Lee

2020

Pediatrics & Neonatology

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“…Population-based studies indicate that acute symptomatic seizures represent 40-50% of all cases of seizures. 12,17 Sartori et al 18 reported that 32.5% of patients with acute symptomatic seizures experienced seizure recurrence at 4-year follow-up. In our study, 83 (60%) patients presented with acute symptomatic seizures.…”

Section: Discussionmentioning

confidence: 99%

Clinical profile and long-term outcome of the first seizures in children

2021

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Background. Seizures are one of the most common causes of pediatric admissions to hospitals in children. This study aims to identify the clinical profile and outcome of first seizures in children. Methods.Children who presented to the pediatric neurology outpatient clinic and pediatric emergency service with a first-time seizure and aged one month through 18 years old were enrolled to the study. At the time of the study, enrolled children were categorized into three study groups according to seizure characteristics: febrile seizure, nonfebrile-provoked seizure and, unprovoked seizure.Results. The study group consisted of 138 children. Of the 138 patients, 60 (43%) had febrile first seizures, 23 (17%) had nonfebrile-provoked first seizures, and 55 (40%) had unprovoked first seizures. The patients did not experience the recurrence of a seizure by the treatment of underlying cause at the eighteenth month and the eighth year follow-up in the nonfebrile-provoked seizure group. Among the children admitted for unprovoked first seizures, 33 (60%) patients had seizure recurrence during 18 month follow-up and 36 (82%) patients had seizure recurrence during eight year follow-up. Seizure recurrence rate was statistically higher in patients with abnormal EEG and cranial MRI findings in the unprovoked seizure group (p <.05). Conclusions.The patients with provoked first seizure did not develop epilepsy during eight year follow-up. However, 36 patients with unprovoked seizures were diagnosed with epilepsy during eight year follow-up. It is essential to determine the causes of the seizures and treat the condition.

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“…Studies has demonstrated that up to 25 to 50% of children with SFS have family history of febrile seizures, suggesting a strong genetic component in febrile seizures. 9 A clear genetic etiology has been identified in some genetic epilepsy syndromes associated with occurrence of febrile seizures. One of the first syndromes identified is genetic epilepsy with febrile seizures plus (GEFSþ).…”

Section: Epidemiology and Pathophysiologymentioning

confidence: 99%

“…The most important predictive risk factors for the development of epilepsy are developmental delay, abnormal neurological exam prior to the febrile seizure, history of complex febrile seizures or febrile status epilepticus, and a first degree relative with epilepsy. 5,9,34 The exact mechanism for development of epilepsy is complex and not fully elucidated. These risk factors may suggest a preexisting predisposition to develop epilepsy.…”

Section: Risk Factors For Recurrence Of Febrile Seizuresmentioning

confidence: 99%

Simple Febrile Seizures: A Benign Phenomena?

Andrade¹

2019

J Pediatr Epilepsy

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Febrile seizures are one of the most common neurological causes of visits to the emergency room. This article is a review of the current literature concerning the evaluation and treatment of children with febrile seizures. Longitudinal prospective studies such as the FEBSTAT study (consequences of prolonged febrile seizures in childhood) have contributed to elucidate the long-term outcome of patients with prolonged febrile seizures. Neurogenetic research also demonstrated the role of genetic mutations (mainly voltage-gated ion channels) in the etiology of febrile seizures. Most febrile seizures are self-limited events with low risk of injury or evolution into status epilepticus or sudden death. However, the use of rectal diazepam as acute abortive treatment for febrile seizures lasting 5 minutes or longer has gained acceptance as a first-line home intervention. Most patients with febrile seizures do not require extensive investigations, but the treatment involves a customized plan. Efforts should be directed to educate caregivers about prognosis and management of potential recurrences. In selected cases, appropriate use of preventive antiseizure medication may be a consideration.

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First‐ever convulsive seizures in children presenting to the emergency department: risk factors for seizure recurrence and diagnosis of epilepsy

Cited by 35 publications

References 44 publications

Children with transient loss of consciousness: Clinical characteristics and the effectiveness of diagnostic tests

Children with transient loss of consciousness: Clinical characteristics and the effectiveness of diagnostic tests

Clinical profile and long-term outcome of the first seizures in children

Simple Febrile Seizures: A Benign Phenomena?

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