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Unprovoked seizures and developmental disabilities: clinical characteristics of children referred to a child
Insights
Children with developmental disabilities have a fourfold higher risk of unprovoked seizures by age 5. Major conditions like cerebral palsy and mental retardation significantly increase this risk, especially when combined.
Area of Science:
- Pediatric Neurology
- Developmental Pediatrics
- Epileptology
Background:
- Limited data exist on seizure risks in young children with developmental problems.
- Child development centers (CDCs) serve diverse populations with developmental disabilities.
Purpose of the Study:
- To determine the cumulative risk of unprovoked seizures in children referred to a CDC.
- To identify risk factors associated with seizures in this pediatric population.
Main Methods:
- Retrospective evaluation of 1,946 children aged 0-5 years referred to the Tel Aviv CDC (1981-1990).
- Kaplan-Meier methodology used to assess cumulative seizure risk and risk factors.
- Multivariate analysis to identify independent predictors of seizures.
Main Results:
- Overall, 3% of children experienced unprovoked seizures by age 5.
- Significant risk factors included cerebral palsy (RR=28.7), neonatal seizures (RR=15.2), mental retardation (RR=7.8), and febrile seizures (RR=7.7).
- Children with mental retardation and/or cerebral palsy had substantially higher seizure risks (8% to 68% by age 5).
Conclusions:
- The cumulative risk of unprovoked seizures by age 5 in children with developmental disabilities is 3%, four times higher than the general population.
- Increased risk is concentrated in subgroups with major disabilities like cerebral palsy and mental retardation.
- Children with developmental issues but without mental retardation or cerebral palsy have a seizure risk similar to the general population.
Abstract:
Few data are available on the risk of seizures in young children with developmental problems. A retrospective evaluation of 1,946 children 0-5 years of age referred to the Tel Aviv Child Development Center (CDC) between 1981 and 1990 was performed. The study was undertaken to determine the cumulative risk of unprovoked seizures in children referred to a CDC and to assess the risk factors associated with seizures in these children. The center serves the Tel Aviv area for a variety of developmental disabilities. Cumulative risk of seizures and risk factors were assessed using Kaplan-Meier methodology. Unprovoked seizures occurred in 58 patients (3%), including 10 with a single seizure and 48 with two or more seizures. Risk factors for seizures included cerebral palsy (CP) (relative risk [RR] = 28.7), neonatal seizures (RR = 15.2), mental retardation (MR) (RR = 7.8), febrile seizures (RR = 7.7), autism (RR = 3.2), and prematurity (RR = 2.7). The cumulative risk of seizures by age 5 years in children with MR, CP, and MR plus CP was 8%, 47%, and 68%, respectively, compared with 1% in those without MR or CP. On multivariate analysis, CP, MR, prior febrile seizures, and prematurity were associated with an increased risk of seizures. The risk of experiencing unprovoked seizures by age 5 in children with developmental disabilities is 3%, which is fourfold greater than that of the general population. Much of this increased risk is limited to selected subgroups with major disabilities. However, if neither MR nor CP is present, the 1% risk of developing unprovoked seizures by age 5 in children with other developmental problems is not substantially different from that expected in the general population.