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Follow-up study of 482 cases with convulsive disorders in the first year of life
Insights
Seizures in the first year of life, particularly infantile spasms and status epilepticus, often lead to poor long-term outcomes. Febrile convulsions showed a more favorable prognosis, with most children developing normally.
Area of Science:
- Pediatric Neurology
- Epileptology
Background:
- Seizures in infancy represent a significant clinical challenge.
- Understanding the long-term neurodevelopmental outcomes of various seizure types is crucial for early intervention.
Purpose of the Study:
- To evaluate the long-term prognosis of infants experiencing seizures within the first year of life.
- To compare developmental outcomes across different infantile seizure classifications.
Main Methods:
- A cohort of 482 patients with early-life seizures was followed for a minimum of five years.
- Patients were categorized into four groups: febrile convulsions, infantile spasms, status epilepticus, and other seizure types.
- Developmental trajectories, including normal development, recurrent seizures, epilepsy, and neurological abnormalities, were assessed.
Main Results:
- Children with febrile convulsions had the highest rate of normal development (62%), contrasting sharply with infantile spasms (14%) and status epilepticus (15%).
- Epilepsy incidence was similar for partial and generalized seizures, but partial seizures were associated with higher rates of mental retardation.
- Favorable outcomes were linked to cryptogenic or febrile seizures, isolated events, later onset (second six months), generalized seizures, and normal interictal EEG.
Conclusions:
- Seizures occurring in the first year of life, especially West syndrome and status epilepticus, carry a generally grave prognosis.
- Early-life seizure type, etiology, and EEG findings significantly influence long-term neurodevelopmental outcomes.
Abstract:
A total of 482 patients who had had one or more seizures in the first year of life were followed for at least five years (most for more than 10 years). The patients were divided into four groups: febrile convulsions, infantile spasms, status epilepticus and 'other'. Of those with febrile convulsions, 62 per cent developed normally, compared with 14 per cent in the group with infantile spasms, 15 per cent with status epilepticus, and 24 per cent in the 'other' group. Findings on recurrent seizures, epilepsy and mental retardation and/or neurological abnormalities are also reported. Epilepsy developed equally frequently among those with partial and with generalised seizures, but the former more frequently became mentally retarded. The effects of severity of seizures and other factors are discussed. In general, this research confirmed the grave prognosis after seizures during the first year of life, and not only for West syndrome and status epilepticus. The outcome was more favourable when the seizures were cryptogenic or febrile, isolated, with onset in the second six months, generalised, and when the EEG was normal between seizures.