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Risk of seizure recurrence following a first unprovoked seizure in childhood: a prospective study
S Shinnar1, A T Berg, S L Moshé
1Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467.
Insights
Most children experiencing a first unprovoked seizure do not have recurrent seizures, especially those with idiopathic seizures and normal electroencephalograms. Treatment with antiepileptic drugs did not impact recurrence risk in this pediatric study.
Area of Science:
- Pediatric Neurology
- Clinical Epilepsy Research
Background:
- First unprovoked seizures in children are a common neurological concern.
- Understanding seizure recurrence risk is crucial for prognosis and management.
Purpose of the Study:
- To determine the recurrence risk of seizures after a first unprovoked seizure in children.
- To identify predictors of seizure recurrence in pediatric patients.
Main Methods:
- Prospective study following 283 children with a first unprovoked seizure.
- Data collected on seizure recurrence, seizure type, electroencephalogram (EEG) findings, family history, and treatment.
- Statistical analysis to identify significant predictors of recurrence.
Main Results:
- 36% of children experienced subsequent seizures.
- Cumulative recurrence risk was 26% at 12 months and 42% at 48 months.
- Idiopathic seizures with normal EEGs had a significantly lower recurrence risk (15% at 12 months) compared to those with abnormal EEGs (41% at 12 months).
- Remote symptomatic seizures with prior febrile seizures or partial seizure occurrence predicted recurrence.
- Antiepileptic drug treatment did not affect recurrence risk.
Conclusions:
- The majority of children with a first unprovoked seizure do not experience recurrence, particularly those with idiopathic seizures and normal EEGs.
- Predictors vary based on seizure etiology (idiopathic vs. remote symptomatic).
- Current antiepileptic drug treatment strategies may not significantly alter recurrence rates in the short to medium term.
Abstract:
In a prospective study, 283 children who presented with a first unprovoked seizure were followed for a mean of 30 months from the time of first seizure. Subsequent seizures were experienced by 101 children (36%). The cumulative risk of seizure recurrence for the entire study group was 26% at 12 months, 36% at 24 months, 40% at 36 months, and 42% at 48 months. The cumulative risk of recurrence in the 47 children with a remote symptomatic first seizure was 37%, 53%, and 60% at 12, 24, and 36 months, respectively, compared with a cumulative risk of 24%, 33%, and 36% at 12, 24, and 36 months, respectively, in the 236 children who had had an idiopathic first seizure (P less than .01). In children with an idiopathic first seizure, the electroencephalogram was the most important predictor of recurrence. The cumulative risk of recurrence in the 81 children with abnormal electroencephalograms was 41%, 54%, and 56% at 12, 24 and 36 months, respectively, but only 15%, 23%, and 26% at 12, 24, and 36 months, respectively, in the 138 children with normal electroencephalograms (P less than .001). A history of epilepsy in a first-degree relative was a significant risk factor only in idiopathic cases with abnormal electroencephalograms. In children with a remote symptomatic first seizure, either a history of prior febrile seizures or the occurrence of a partial seizure were significant predictors of recurrence. Age at first seizure and duration of seizure did not affect recurrence risk in either the idiopathic or remote symptomatic group. A total of 84% of the children were not treated with antiepileptic drugs or were treated for less than 2 weeks. Only 9% were treated for longer than 3 months. Treatment did not affect the risk of recurrence. The results suggest that, even without treatment, the majority of children with a first unprovoked seizure will not experiment a recurrence. Children with an idiopathic first seizure and a normal electroencephalogram have a particularly favorable prognosis.