Prevalence and Predictors of Seizure Clusters in Pediatric Patients With Epilepsy: The Harvard-Yale Pediatric Seizure
Saba Jafarpour1, Michael W K Fong2, Kamil Detyniecki3
1Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Division of Neurology, Children's Hospital of Los Angeles, Los Angeles, California.
Insights
Seizure clusters are common in pediatric epilepsy patients, with high seizure frequency being the strongest predictor. Rescue medications are underused, indicating a need for better treatment strategies.
Area of Science:
- Neurology
- Pediatric Epilepsy Research
Background:
- Seizure clusters are a significant concern in pediatric epilepsy.
- Understanding their prevalence, associated risks, and predictive factors is crucial for effective management.
Purpose of the Study:
- To determine the prevalence of seizure clusters in pediatric epilepsy patients.
- To identify risk factors associated with seizure clusters.
- To assess the use of rescue medications and adverse outcomes.
Main Methods:
- A prospective, observational, two-center study followed 297 pediatric epilepsy patients for 12 months.
- Patients were categorized into high, intermediate, and low-risk groups based on prior seizure activity.
- Data collection included phone calls and seizure diaries.
Main Results:
- Seizure clusters occurred in 32.3% of patients, affecting nearly half of those with active seizures at baseline.
- Higher seizure frequency (≥4/month), history of status epilepticus, and high-risk status predicted increased odds of seizure clusters.
- Emergency room visits and injuries were not more frequent with seizure clusters than isolated seizures.
Conclusions:
- Seizure clusters are prevalent in pediatric epilepsy, with high seizure frequency being a key predictor.
- Rescue medication utilization was low, suggesting a need for improved treatment protocols.
- Further research is needed to optimize treatment and reduce adverse events associated with seizure clusters.
Background:
Determine the prevalence of seizure clusters (two or more seizures in six hours), use of rescue medications, and adverse outcomes associated with seizure clusters in pediatric patients with a range of epilepsy severities, and identify risk factors predictive of seizure clusters.
Methods:
Prospective observational two-center study, including phone call and seizure diary follow-up for 12 months in patients with epilepsy aged one month to 18 years. We classified patients into three risk groups based on seizures within the prior year: high, seizure cluster (two or more seizures within one day); intermediate, at least one seizure but no days with two or more seizures; low, no seizures.
Results:
One-third (32.3%; high risk, 72.4%; intermediate risk, 30.4%; low risk, 3.1%) of 297 patients had a seizure cluster during the study, including half (46.2%) of the patients with active seizures at baseline (intermediate- and high-risk groups combined). Emergency room visits or injuries were no more likely due to a seizure cluster than an isolated seizure. Rescue medications were utilized in 15.8% of patients in the high-risk group and 19.2% in the intermediate-risk group. History of status epilepticus (adjusted odds ratio [aOR], 2.13; confidence interval [CI], 1.09 to 4.16]), seizure frequency greater than four per month (aOR, 4.27; CI, 1.92 to 9.50), and high-risk group status (aOR, 6.42; CI, 2.97 to 13.87) were associated with greater odds of seizure cluster.
Conclusions:
Seizure clusters are common in pediatric patients with epilepsy. High seizure frequency was the strongest predictor of clusters. Rescue medications were underutilized. Future studies should evaluate the applicability and effectiveness of these medications for optimization of pediatric seizure cluster treatment and reduction of seizure-related emergency department visits, injuries, and mortality.
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