The Frequency and Precipitating Factors for Breakthrough Seizures in Children with Epilepsy
Abdullah Nasser Aldosari1, Ahmed Alghamdi1, Ayidh Alharthi1
1Department of Pediatrics, King Fahad Hospital, Al Baha, Saudi Arabia.
Insights
Systemic infections with fever and medication non-compliance are the most common triggers for breakthrough seizures in children. Educating parents can help prevent these seizures.
Area of Science:
- Pediatric Neurology
- Epilepsy Research
Background:
- Epilepsy is a chronic neurological disorder affecting children.
- Breakthrough seizures occur despite ongoing anti-seizure medication.
Purpose of the Study:
- To identify common precipitating factors for breakthrough seizures in pediatric epilepsy patients.
- To inform strategies for seizure prevention and management.
Main Methods:
- Retrospective chart review of 108 children (1-14 years) with epilepsy.
- Inclusion criteria: diagnosis by International League Against Epilepsy, seizure-free for ≥2 months prior to breakthrough seizure.
- Data collected on demographics, precipitating factors, and EEG findings.
Main Results:
- Systemic infection with fever (52.8%) and medication non-compliance (34.3%) were the most frequent triggers.
- 88% of patients reported at least one precipitating factor.
- Parental awareness of triggers was low (30.5%).
Conclusions:
- Systemic infections and medication non-compliance are key triggers for breakthrough seizures in children.
- Enhanced parental education on seizure triggers is crucial for prevention.
- Further research, including RCTs, is needed to optimize medication management during infections.
Background And Purpose:
To determine the common precipitating factors for breakthrough seizures in children with epilepsy.
Methods:
This retrospective study reviewed the charts of children with epilepsy who were followed up in the pediatric neurology clinic of King Fahad Hospital in Al-Baha region, Saudi Arabia, between January 2015 and August 2022. Children between 1 to 14 years of age who had epilepsy, as per the International League Against Epilepsy definition and received anti-seizure medication with a seizure-free period of at least 2 months before breakthrough seizure episode, were included in the study.
Results:
Of the 108 children included in the study, the mean age was 6.8±1.6 years, and among them (55.5%) were male. Most parents (69.5%) were unaware of the triggering factors of seizure. The majority of patients (88%) reported at least one precipitating factor for breakthrough seizures and the most common one was systemic infection associated with fever (52.8%), and then non-compliance to medications in (34.3%) of the patients. In terms of the electroencephalogram, around 84 patients (77.8%) had abnormal electroencephalogram. Finally, monotherapy was maintained in 63.9% of patients.
Conclusions:
We conclude that the most common trigger for breakthrough seizure is a systemic infection associated with fever and non-compliance to anti-seizure medications. Increasing the level of awareness by different methods may help limit or even prevent seizures from occurring. Randomized controlled trials could shed light on the adjustment of anti-seizure medications temporarily by increasing the dosage or giving extra doses during the infection to avoid breakthrough seizures.
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