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Risk of recurrence after a single, unprovoked, generalized tonic-clonic seizure
J Boulloche1, P Leloup, E Mallet
1Paediatric Unit, Hôpital Charles Nicolle, Rouen, France.
Insights
Recurrence risk after a single generalized tonic-clonic seizure in children is significant, with most events occurring within two years. Treatment status did not impact recurrence rates.
Area of Science:
- Pediatric Neurology
- Epileptology
Background:
- Generalized tonic-clonic seizures (GTCS) are common in childhood.
- Predicting recurrence risk is crucial for management and prognosis.
Purpose of the Study:
- To assess the long-term recurrence risk following a first unprovoked GTCS in children.
- To identify factors influencing seizure recurrence.
Main Methods:
- A cohort of 119 children (2-16 years) with a single unprovoked GTCS was followed.
- Inclusion criteria: normal neurological exam, normal intellectual development, and normal EEG (no focal abnormality).
- Recurrence risk was calculated over 8 years; EEG findings and clinical factors were analyzed.
Main Results:
- The cumulative recurrence risk was 28.5% at 1 year, 32.6% at 3 years, and 37.7% at 8 years.
- 58% of recurrences happened within 6 months, and 87% within 2 years.
- EEG abnormalities (spikes and waves, photoparoxysmal discharges, slowing) did not significantly alter recurrence risk compared to normal EEGs.
Conclusions:
- The risk of recurrence after a single unprovoked GTCS in children is substantial, particularly within the first two years.
- Initial EEG findings and clinical factors like age, seizure duration, and family history did not significantly predict recurrence.
- Treatment did not appear to influence the risk of seizure recurrence.
Abstract:
A cohort of 119 two- to 16-year-old patients was followed to assess the risk of recurrence after a single, unprovoked, generalized tonic-clonic seizure. Only children with a normal neurological examination and intellectual development, and an EEG showing no focal abnormality, were studied. The risk of recurrence at six months was 22 per cent, at one year 28.5 per cent, at three years 32.6 per cent and at eight years 37.7 per cent. 58 per cent of recurrences occurred within the first six months and 87 per cent within the first two years. Initial EEGs showing generalized, unprovoked spikes and waves, generalized paroxysmal discharges precipitated by intermittent photic stimulation, or isolated slowing, were associated with risks of recurrence at two years of 40, 50 and 26 per cent, respectively. These results do not differ significantly from those obtained when the initial EEG was normal (29 per cent). Age, seizure duration and history of epilepsy in the family were not associated with a significantly higher risk of recurrence. The risk of recurrence was similar for treated and untreated patients.