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Risk of seizure recurrence after a first unprovoked seizure in childhood
Yuichi Takami1, Taku Nakagawa1
1Department of Pediatrics, Japanese Red Cross Society Himeji Hospital, Hyogo, Japan.
Insights
Over half of children experienced seizure recurrence after a first unprovoked seizure. However, prognosis remained good overall for these pediatric epilepsy patients.
Area of Science:
- Pediatric Neurology
- Epilepsy Research
- Clinical Neurophysiology
Background:
- First unprovoked seizures in children are common, with recurrence posing a significant concern.
- Understanding recurrence risk factors is crucial for appropriate management and prognosis.
Purpose of the Study:
- To evaluate the risk of seizure recurrence following a first unprovoked seizure in children.
- To identify factors correlating with seizure recurrence and analyze the relationship between first and second seizures.
Main Methods:
- A prospective study included 467 children (1 month–16 years) with a first seizure, excluding those on antiepileptic drugs.
- Kaplan-Meier survival analysis calculated recurrence rates.
- Cox proportional hazards models and kappa coefficient assessed recurrence risk and correlations.
Main Results:
- Recurrence occurred in 60% of children, with 91.4% of recurrences happening within 2 years.
- Estimated recurrence risks were 39.5% at 6 months and 61.8% at 10 years.
- Abnormal EEG and neuroimaging significantly increased recurrence risk; first/second seizures correlated with arousal state, status epilepticus, and multiple seizures.
Conclusions:
- More than half of untreated children experienced recurrence after a first unprovoked seizure.
- Despite high recurrence rates, the overall prognosis for these children was favorable.
- Abnormal EEG and neuroimaging are key predictors of recurrence in pediatric epilepsy.
Objective:
The aim of this study was to assess the risk of recurrence after a first unprovoked seizure in childhood and to explore the correlation between the first and second seizures in recurrent patients.
Methods:
In a prospective study, we included 467 children aged 1 month to 16 years, who were attended to between November 1, 2008 and October 31, 2016 following a first seizure. Children who had been started on treatment with antiepileptic drugs were excluded. Recurrence rates were calculated using Kaplan-Meier survival analyses. Univariate and multivariate analyses for recurrence risk were performed using the Cox proportional hazards model. The kappa coefficient of correlation for categorical data was calculated.
Results:
Recurrences occurred in 280 children (60.0%), of which 75 (26.8%) occurred in the first month, 184 (65.7%) within 6 months, and 256 (91.4%) within 2 years. None of the patients had new neurologic sequelae after their first or second seizure. The estimates of seizure recurrence risk were 39.5%, 48.1%, 55.1%, 60.8%, 61.8% and 61.8% at 0.5, 1, 2, 5, 8, and 10 years after the first seizure, respectively. Multivariate analysis showed that abnormal electroencephalogram and neuroimaging findings significantly increased the risk of recurrence. First and second seizures were significantly associated with state of arousal, status epilepticus, and multiple seizures in recurrent patients.
Conclusion:
Over half of untreated children had recurrence after a first unprovoked seizure, but prognosis was good overall.
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