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Risk factors for seizure recurrence in children after first unprovoked seizure
Sonoko Mizorogi1, Hideaki Kanemura1, Fumikazu Sano1
1Department of Pediatrics, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan.
Insights
Recurrence is common after a first unprovoked seizure in children, often within one year. Partial seizures and abnormal EEG findings increase the risk of seizure recurrence.
Area of Science:
- Pediatric Neurology
- Epilepsy Research
- Clinical Neuroscience
Background:
- The management of first unprovoked seizures in children remains a clinical challenge.
- Uncertainty exists regarding the optimal treatment strategy post-seizure.
Purpose of the Study:
- To evaluate the time to seizure recurrence in children after a first unprovoked seizure.
- To identify significant risk factors associated with seizure recurrence in pediatric patients.
Main Methods:
- A prospective study involving children aged 1 month to 15 years with a first unprovoked afebrile seizure.
- Participants were followed for at least 2 years to monitor seizure recurrence.
- Statistical analyses included log-rank tests and hazard ratios to assess recurrence risk factors.
Main Results:
- Over half (57.5%) of the 73 subjects experienced seizure recurrence.
- Recurrence rates were 61.9% at 6 months, 85.7% at 1 year, and 95.2% at 2 years.
- Partial seizures (69.0%) and abnormal EEG with focal epileptic discharge (61.9%) were significantly associated with higher recurrence rates.
Conclusions:
- Seizure recurrence after a first unprovoked event often occurs within 6 months to 1 year.
- Partial seizure type and focal epileptic discharge on EEG are identified as key risk factors for recurrence in children.
Background:
The question of whether to treat a patient after a first unprovoked seizure is controversial. This prospective study assessed the time to recurrence and risk factors for seizure recurrence after a first unprovoked seizure in children.
Methods:
Participants were recruited between 1 July 1997, and 30 June 2009. Eligible candidates were children between 1 month and 15 years old who presented with their first unprovoked afebrile seizure. After enrollment, recurrence of seizures was investigated. All participants were followed for at least 2 years. Log-rank test was used for bivariate analysis to check associations, and hazard ratios were used to analyze variables and clinical outcome (recurrence) during follow-up.
Results:
Of 73 subjects, 42 (57.5%) experienced recurrence. The overall product-limit estimate of recurrence was 61.9% at 6 months, 85.7% at 1 year, and 95.2% at 2 years after seizure onset, respectively. Incidence of recurrence with partial and generalized seizures was 69.0% and 31.0%, respectively. Children with partial seizures had recurrence significantly more often than those with generalized seizures (P < 0.001). Recurrent seizures occurred after normal findings on electroencephalogram (EEG) in 21.4%, after generalized spike-and-wave complexes in 16.7%, and after focal epileptic discharge in 61.9%. Children with focal epileptic discharge had recurrence significantly more often than children with normal EEG findings (P < 0.001).
Conclusion:
The time to seizure recurrence after first unprovoked seizure may be within 1 year, and particularly within 6 months; and partial seizure and abnormal EEG with focal epileptic discharge may be risk factors for seizure recurrence.
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