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What is the safe observation period for seizure recurrence in pediatric emergency departments?
Emel Ulusoy1, Şebnem Uysal Ateş2, Hale Çitlenbik1
1Dokuz Eylul University, Faculty of Medicine, Department of Pediatrics, Division of Pediatric Emergency Care, Izmir, Turkey.
Insights
Afebrile seizures in children often recur within 6 hours, especially in those with a history of febrile seizures or EEG abnormalities. Early observation in emergency departments is crucial for managing seizure recurrence risk.
Area of Science:
- Pediatric Neurology
- Emergency Medicine
Background:
- Afebrile seizures are a common reason for pediatric emergency department visits.
- Limited data exists on seizure recurrence timing and risk factors in emergency care follow-up.
Purpose of the Study:
- To determine the seizure recurrence time in children with afebrile seizures.
- To identify risk factors associated with early seizure recurrence.
Main Methods:
- A study included 623 pediatric patients (1 month to 18 years) with afebrile seizures.
- Data collected included seizure recurrence, demographics, epilepsy diagnosis, EEG, imaging, and treatments.
- Seizure recurrence times and associated risk factors were analyzed.
Main Results:
- Seizure recurrence was observed in 23.9% of patients, with a median recurrence time of 1 hour.
- 86% of recurrences occurred within 6 hours, and 95.3% within 12 hours.
- Risk factors for recurrence included prior febrile seizures, no benzodiazepine therapy, structural abnormalities, and cluster seizures.
Conclusions:
- Patients with a history of febrile seizures, structural abnormalities, cluster seizures, or EEG abnormalities are at higher risk for early recurrence.
- The first 6 hours post-seizure are critical for monitoring recurrence risk in pediatric patients.
Background:
Afebrile seizures are the common causes of emergency department (ED) admissions in childhood, and there is limited data on the observation period in emergency service follow-up of these patients in terms of seizure recurrence in the literature. This study aims to determine the seizure recurrence time in afebrile seizures and the risk factors that determine it.
Methods:
Patients aged between 1 month and 18 years with afebrile seizures were included in the study. Seizure recurrence times, demographic data, diagnosis of epilepsy, use of antiseizure medications, Electroencephalography (EEG) and imaging results, structural abnormalities, hospitalizations, and treatments were recorded.
Results:
The median age of 623 patients included in the study was 42 months (16.0-94.0 months) and 59.9% were male. Epilepsy was diagnosed in 372 (59.7%) of the patients. Short-acting benzodiazepine was administered in 249 of the cases. The mean observation time of the patients was 36 hours (24-98 hours). Electroencephalography (EEG) was applied in 437 (70.1%) of the patients and abnormality was detected in 53.5%. Seizure recurrence was observed in 149 patients (23.9%). The median time of seizure recurrence was 1.0 hour (0.5-4.0 hours). Eighty-six percent of the seizure recurrences (n = 129) occurred within the first six hours and 95.3% (n = 142) within the first 12 hours. Risk factors included a history of febrile seizures (p = 0.001, OR = 2.7), not receiving short-acting benzodiazepine therapy (p = 0.026, OR 1.7), previous structural abnormalities (p = 0.018, OR 1.8), and cluster seizures (p = 0.001, OR 6.7) for all patients and also EEG abnormalities in pediatric ED for first seizure (p = 0.012, OR 2.4).
Conclusion:
Patients with a history of febrile seizure, previous structural abnormalities, cluster seizures, EEG abnormalities in pediatric ED, and patients who didn't receive BZD treatment were at risk for seizure recurrence in the early period. Since most seizure recurrences occur within the first 6 hours, this period is the most critical time for recurrence risk.
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