Seizure recurrence risk following a first seizure in neurologically normal children

Abstract

Summary Purpose: To define seizure recurrence rates in normal children who had had a single seizure and to define electroencephalography (EEG) or magnetic resonance imaging (MRI) utility in predicting seizure recurrence. Methods: We studied 150 children (6 to 14 years) with a first afebrile, unprovoked seizure. Inclusion criteria were: Normal physical and neurological examination, undergone EEG and MRI studies of the brain, and followed for at least 27 months. These children participated in an ongoing prospective study of new onset seizures in childhood. Results: The seizure recurrence rate was 66.4%. An abnormal EEG had no association with seizure recurrence at 9, 18, or 27 months (p = 0.1806, p = 0.2792, and p = 0.2379, respectively). A “significant” MRI abnormality, which occurred in 16.0% of patients, was associated with an increased seizure recurrence risk at 9 months (p = 0.0389) but not at 18 or 27 months. Discussion: EEG findings poorly predict recurrence after a single seizure. The high rate of MRI abnormalities suggests that MRI may need consideration as a routine test to evaluate epilepsy in normal children.

Nested Case-Control Study of Children Presenting with First Afebrile Seizure at KKH: Seizure Recurrence and Comorbidities

“…A prospective, larger scale study would permit more definitive conclusions. It is reassuring that the results of this study are consistent with larger prospective studies conducted elsewhere [5][6][7] . Though the questionnaire was translated into Mandarin Chinese, significant variability is seen in the level of proficiency of respondents.…”

Paediatric new‐onset seizure clinic in Australia: Experience and lessons learnt

“…In our cohort, more children had generalised epileptiform discharges (55%) compared to the 24–35% reported previously, whereas the percentage with focal discharges was lower (44 vs. 57%). In keeping with the EEG findings, there was a higher ratio of generalised (52 vs. 43%) to focal epilepsy in our cohort compared to the literature, where generalised epilepsies have constituted 29–35% of newly diagnosed seizures . The difference may have been due to local practices and referral patterns.…”

“…A diagnosis of ‘EP+’ was made in 109 children (55%). The EEG is immensely helpful in the diagnosis of epilepsy as well as the choice of AED . The number of children and adults with epileptiform discharges on EEG after new‐onset seizures has varied widely (12–56%) in previous studies; in our study, it was 54.5%.…”

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

“…Indeed, global developmental delay and intellectual disability have been reported as risk factors for seizure recurrence after a first ‘unprovoked seizure’ in children . Other studies on ‘unprovoked seizures’ disclosed variable rates of recurrence between about 35% and 65%, depending on the different lengths of follow‐up (2–5y) and the designs and case definitions used . Factors significantly related to risk of seizure recurrence in our study were the ‘unprovoked’ nature of the first seizure, multiple seizures in the first 24 hours, a positive family history of febrile seizure or epilepsy, and pre‐existing neurological conditions or problems (Table ).…”