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Outcome of seizures in the first year of life
U Kramer1, A Phatal, M Y Neufeld
1Institute for Child Development, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel.
Insights
Infantile seizures starting in the first year of life are common, with partial seizures often symptomatic and having a poor prognosis. Generalized seizures may be severe or benign with good outcomes.
Area of Science:
- Pediatric Neurology
- Epileptology
- Clinical Neuroscience
Background:
- Seizures in infancy represent a significant clinical challenge.
- Understanding the long-term outcomes of early-onset seizures is crucial for effective management.
- West syndrome is a common diagnosis for infantile-onset seizures, but other seizure types also occur.
Purpose of the Study:
- To determine the incidence of seizures beginning in the first year of life.
- To investigate the natural history and long-term prognosis of these early-onset seizures.
- To differentiate outcomes based on seizure type and etiology.
Main Methods:
- Retrospective analysis of patient records from a pediatric neurology clinic (1975-1995).
- Inclusion criteria: seizure onset prior to 16 years of age.
- Classification of seizure types and assessment of symptomatic vs. cryptogenic origins.
Main Results:
- 80 out of 482 patients (16.6%) experienced seizure onset between 1-12 months of age.
- West syndrome accounted for 48% of these cases; partial seizures were the most frequent non-West type (19%).
- At a mean follow-up of 10 years, 50% of non-West syndrome patients still had seizures; partial seizures were frequently symptomatic (73%) and persistent (71%).
Conclusions:
- Partial seizures with onset in infancy are often symptomatic and associated with an unfavorable prognosis.
- Generalized seizures in this age group can be either severe or cryptogenic, with the latter typically responding well to treatment.
- Early seizure classification and etiological assessment are vital for predicting long-term outcomes in infantile epilepsy.
Aim:
To determine the frequency and natural history of seizures having an onset during the first year of life.
Methods:
A retrospective analysis of the files of all patients treated in the paediatric neurology clinic of our medical centre during 1975-1995.
Results:
Of our 482 patients with seizure onset prior to age 16 years, the first seizure occurred at age 1-12 months in 80 (16.6%). Of those, 38 (48%) had West syndrome and the rest were classified as follows--partial seizures with or without secondary generalization: 19%, generalized tonic seizures: 8.5%, generalized tonic-clonic seizures: 7.5%, myoclonic: 7.5%, unclassified: 7.5%, and mixed-type seizures: 2%. Follow-up was possible in 91% of the patients. Mean follow-up period from seizure onset was 10 years. Of the non-West syndrome patients who were followed, 19 (50%) were still experiencing seizures at follow-up. Eleven of the 15 patients (73%) with partial seizures and four of the 13 patients (31%) with generalized tonic or tonic-clonic seizures had symptomatic seizures. Of the 14 followed patients with partial seizures, 10 (71%) still had seizures at follow-up, as did three (25%) of the 12 followed patients with generalized tonic or tonic-clonic seizures (p = 0.023).
Conclusions:
The partial seizures were most often symptomatic with unfavourable prognosis, while the generalized seizures were either symptomatic and severe or cryptogenic and rapidly responsive to anti-epileptic drugs with good outcome.
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