Prognosis of seizures occurring in the first year

To determine whether predictors of neurodevelopmental outcome and the course of epilepsy can be identified in infants 1-12 months of age presenting with their first afebrile seizure, we collected demographic data, seizure details (type, frequency, duration, etiology, and treatment), developmental status, neurologic findings at presentation and follow-up, and electroencephalographic (EEG), neuroimaging, metabolic, hematologic, and chemistry test results by chart review, parental interview, and neurologic examination in 40/41 subjects (98%) presenting to our institution between January 1994 and December 1998. The mean duration of follow-up from onset of seizures was 29 months (S.D. = 17; range = 1-64). Predictors of developmental and neurologic abnormalities at follow-up included developmental delay and abnormal neurologic examination at presentation, infantile spasms, lack of response to antiepileptic drugs (AEDs), valproate use, and abnormal EEG or neuroimaging results. Predictors against seizure control and epilepsy remission and for the development of problematic seizures at follow-up included valproate use and lack of response to AEDs. Poor neurodevelopmental outcome of children with new-onset afebrile seizures in the first 1-12 months of age can be accurately predicted at diagnosis with the aid of EEG and neuroimaging studies. The course of epilepsy is more difficult to predict, but failure to respond to the first AED is worrisome.