Risk of seizure recurrence following a first unprovoked seizure in children

The aim of the study was to determine seizure recurrence rate and risk factors of a first unprovoked seizure in children. Ninety-one children aged 2 months-15 years who had a first unprovoked seizure were enrolled and followed-up. History and physical examination were undertaken. The results were displayed as a Kaplan-Meier survival curve. Multivariate analysis was performed with Cox proportional-hazards model. The cumulative probability of recurrence rate was 68 per cent and incidence density was 6.85 per 100 person-months. The cumulative risk of recurrence was 50 per cent at 4 months and 66 per cent at 12 months. No risk of seizure recurrence was found in this study.     

Risk of recurrent seizures after the first afebrile grand mal seizure in childhood]

A cohort of 74 children three months to 16 years-old who presented with a first unprovoked seizure were followed for five years to assess the risk of recurrence. Children with febrile convulsions, immediate posttraumatic seizures, meningitis and encephalitis were not included. The risk of recurrence was 68% for a second seizure. 47% of the patients developed an epilepsy. 85% of recurrences occurred within the first 6 months and 100% within 2 1/2 years. A history of epilepsy in a first degree relative, age at first seizure, duration of seizure, initial EEG or neurologic status were not associated with significantly higher risk of recurrence.     

Recurrence risk after first febrile seizure and effect of short term diazepam prophylaxis.

In a prospective randomised study, 289 children admitted consecutively to hospital with their first febrile seizure were allocated, by date of admission, to short term diazepam prophylaxis (n = 152) or to no prophylaxis (n = 137) and followed for 18 months. In untreated children, five major risk factors for recurrent febrile convulsions were identified: age 15 months or less at the time of the first febrile seizure, epilepsy in first degree relatives, febrile convulsions in first degree relatives, a first complex febrile seizure, and day nursery care. The 18 month recurrence rate was 80 to 100% if three to five risk factors were present, 50% if two factors were identified, 25% where one factor was found, and 12% if there were no predictors. During prophylaxis the recurrence rate was uniformly low (mean 12%) in all risk groups. In high (three or more factors) and intermediate (two factors) risk children prophylaxis provided effective seizure control and reduced the recurrence rate from 80%, or more, to 12% and 50% to 12%, respectively. In children with one risk factor 50% of all recurrences were prevented (25% to 12%). Prophylaxis was ineffective in very low risk children (12% to 12%).     

Frequency of fever episodes related to febrile seizure recurrence

The aim of this study was to assess the number of fever episodes as a risk factor for febrile seizure recurrence during the first 6 months after the last previous febrile seizure. In a 6-month follow-up study of 155 children, aged 3 months to 5 y, with a first or a recurrent febrile seizure, the occurrence of fever episodes and febrile seizure recurrences was prospectively documented. Using logistic regression analysis the association between the baseline characteristics and the number of fever episodes and the outcome, a febrile seizure recurrence, was studied. In total, 260 fever episodes were registered; 29 children experienced 1 or more febrile seizure recurrence during follow-up. Two factors were associated with febrile seizure recurrence: the number of fever episodes [odds ratio (OR) = 1.8; 95% confidence interval (CI): 1.4-2.4)] and age at study entry (OR = 0.6; 95% CI: 0.3-1.1). In a multivariable model, only the number of fever episodes remained significant. In conclusion, the number of fever episodes increases the risk of a febrile seizure recurrence with a factor of 1.8 per fever episode in the first 6 months after a febrile seizure.     

Recurrence risk after withdrawal of antiepileptic drugs in children with epilepsy: A prospective study

AimTo study recurrence risk after withdrawal of antiepileptic drugs in children with epilepsy.MethodsAll children younger than 14 with two or more unprovoked seizures 24 h apart who were seen at our Hospital between 1994 and 2004 were included consecutively and prospectively followed. Patients previously examined in other centres were excluded. All patients who entered a remission were proposed to stop medication and were followed.ResultsThree hundred and fifty three children with two or more unprovoked seizures were attended. A total of 238 entered a remission period and were proposed to stop medication, 216 accept. Mean seizure-free time before medication withdrawal was 2.2 years. Kaplan-Meier estimate of recurrence risk was 23% at 2 years (95% CI: 17–29) and 28% at 5 years (95% CI: 22–34). A remote symptomatic etiology, various seizure types and a history of prior febrile seizures or prior neonatal seizures were associated with a significant increase in recurrence risk in univariable and multivariable analyses using Cox proportional hazards model. Recurrence risk at 2 years was 17% (95% CI: 11–23) for idiopathic/cryptogenic epilepsies and 41% (85% CI: 28–54) for remote symptomatic epilepsies. Recurrence risks at 2 years by epileptic syndrome were West syndrome (0%), benign rolandic epilepsy (10%), epilepsy without unequivocal partial or generalized seizures (11%), benign infantile seizures (13%), absence epilepsy (16%), cryptogenic partial epilepsies (20%), symptomatic partial epilepsies (45%), symptomatic generalized epilepsies (54%).ConclusionsRecurrence risk after withdrawal of antiepileptic treatment in children is low. Etiology and syndromic diagnosis are the main predictive factors.     

Significant findings on cranial CT scan after a first unprovoked seizure in children from North India

Neuroimaging after a first unprovoked seizure may show significant abnormalities. In our study, 32% of all children with a first apparent unprovoked seizure had an abnormal CT scan result. Most of these were ring-enhancing lesions of cysticercal or tubercular origin.     

Management of the first convulsive seizure

OBJECTIVE: To observe the wide variety of reported prognosis after a first unprovoked convulsion and of risk factors that are associated with recurrence, and a uniform conduct. SOURCES: Systematic review of Bireme. SUMMARY OF THE FINDINGS: Recurrence rates differ from a first seizure study because of different inclusion criteria. The EEG is particularly helpful to support the epileptic nature of the event in younger patients and in those with seizures of unknown origin. An abnormal EEG, particularly the ones with generalized spike-wave discharges, has been reported as a consistent predictor of recurrence. Although not a substitute for the clinical examination, the EEG is an integral part of the diagnostic process after the first afebrile seizure and should be requested. The actual decision regarding whether or not to treat patients who present an initial seizure depends heavily on the physiciańs assessment of the potential morbidity of another seizure versus the potential morbidity of antiepileptic drugs (AEDs) therapy. CONCLUSIONS: In children, side effects of AEDs are common, and the risk of injury from a seizure is usually minimal because children neither drive nor operate heavy machinery and are usually in supervised environment. Regarding adults, there is little unanimity.     

Discontinuing anti-epileptic medication(s) in epileptic children: 18 versus 24 months

For a period of slightly over 4 years, 80 children who had been seizure-free for at least 18 months while on anti-convulsant medication were prospectively collected. These 80 children were randomly assigned to either the 18-months seizure-free group (n = 41) or to the group where anti-convulsant medications were continued for another 6 months before they were gradually tapered off and stopped, i.e. the 24-months seizure-free group (n = 39). Twelve (29%) of the 41 children who had been seizure-free for 18 months and 14 (36%) of the 39 children who had been seizure-free for 24 months had seizure recurrence during the follow-up period. Log-rank test of the recurrence experience of the two groups of patients showed no statistically significant difference between the groups (p > 0.50). Similarly, when both groups were combined and other risk variables likely to influence the rate of seizure recurrence were tested, only EEG abnormality at discontinuation of anti-convulsant medication had a significant association with the risk of seizure recurrence (p < 0.001).     

Factors affecting the yield of pediatric EEGs in clinical practice

Clinical factors affecting the yield of 2,500 pediatric electroencephalograms were analyzed. Electroencephalograms were interpreted as epileptiform in 40% of children with epilepsy. Most electroencephalograms were ordered for seizure in children not taking anti-epileptic drugs; just 15% showed epileptiform features. Six percent of electroencephalograms were epileptiform in non-seizure patients. The neurologist significantly influenced the odds of epileptiform interpretation (P = 0.022) and the recommendation to repeat the electroencephalogram (P < 0.001). In practice most electroencephalograms ordered for seizure are actually for non-seizure. In routine pediatric practice, electroencephalography has a low yield and appears to be over-used.     

Treatment of newly diagnosed pediatric epilepsy: a community-based study

OBJECTIVE: To determine the patterns and frequency of treatment and use of specific drugs for newly diagnosed pediatric epilepsy. DESIGN AND SETTING: Prospective, community-based study. Children were recruited from physicians in Connecticut from 1993 to 1997. PATIENTS: Children aged 1 month through 15 years at the time of their first seizure, who had 2 or more unprovoked seizures, and who were newly diangosed during the recruitment period were eligible. MAIN OUTCOME MEASURE: Initiation of treatment at diagnosis and within 1 year after diagnosis of epilepsy. RESULTS: Of 613 children, 482 (78.6%) were treated at the time of initial diagnosis. By 6 months another 10.3% were treated, and by 12 months 90% of the cohort had been treated. The most commonly prescribed antiepileptic drug (AED) was carbamazepine (38.8%) followed by sodium valproate (18.4%). Only 1 child received an investigational drug and none received any of the most recently approved drugs as a first AED. Children with idiopathic and secondarily generalized forms of epilepsy were most likely to be treated (90%-100%), whereas children with idiopathic localization-related epilepsy were least likely to be treated (50.8%). Approximately 80% of those with other forms of epilepsy were treated at the time of diagnosis. Use of specific medications reflected current guidelines and recommendations for treatment of specific seizure types and syndromes. CONCLUSIONS: In Connecticut, approximately 20% of children with epilepsy are not treated at the time of initial diagnosis, and around 10% continue to be untreated after 1 year. This most likely reflects the increased understanding of the nature of pediatric epilepsy and concerns regarding the adverse effects of AEDs. The most commonly used first drugs are carbamazepine and valproate. Follow-up of this cohort may help provide information to guide the use of recently approved AEDs.     

Indications for intermittent diazepam prophylaxis in febrile seizures

BACKGROUND: In a prospective controlled study we evaluated the efficacy of intermittent diazepam prophylaxis in the recurrence rate of febrile seizures (FS). PATIENTS: A total of 139 children aged between 6 and 36 months, who had a first FS, were enrolled in the study and were randomly allocated to two groups: group (A) that received diazepam prophylaxis and group (B) without prophylaxis. METHODS: All children were followed up for at least 3 years after their first FS. The prophylaxis group (n = 68) received rectal diazepam the first two days of a febrile illness, whenever the temperature was > 38 degrees C (0.33 mg/kg every 8 h on the first day, and 0.33 mg/kg every 12 h on the second day of fever, max. dosage 7.5 mg). The no-prophylaxis group (n = 71) did not receive any prophylaxis at all. Each group was stratified to low, intermediate and high risk subgroups according to the following clinical data: age at the first febrile seizure 相似文献   

Status epilepticus in children: Causes,clinical features and short‐term outcome

Background: We aimed to evaluate the cause, clinical profile, and short‐term outcome of status epilepticus cases that were admitted to our pediatric emergency unit between 1 January and 31 December 2008. Methods: We studied the clinical features of 59 seizures that occurred in 56 patients aged between 3 months and 15 years with the diagnosis of status epilepticus. We observed the clinical course and outcome of 53 cases for 6 to 18 months. The correlation between the cause of the seizure and the patient's age at the time of status epilepticus was evaluated as well as the correlation between the risk of seizure recurrence and family history of seizure, the neurological status of the patient prior to seizure and the presence of epilepsy. Results: The most common cause of status epilepticus is febrile illness in children younger than 2 years and idiopathic/cryptogenic and remote symptomatic causes in children older than 2 years. The rate of recurrence of seizure was significantly higher in cases with existing neurological abnormalities, prior epilepsy and seizures with remote symptomatic causes. The most common triggering factors of status epilepticus development in cases with epilepsy were noncompliance for anti‐epileptic drugs and infectious fever. Conclusions: In our study, the risk factors for seizure recurrence were the presence of prior epilepsy, existence of neurological abnormalities and remote symptomatic causes. We argue that improving the compliance of patients and their families to take medicine appropriately and training them in how to cope with febrile illnesses may decrease the recurrence of seizures.     

Duration of recognized fever in febrile seizure predicts later development of epilepsy

Background: The current report examines the risk of and predictors for developing epilepsy in children with febrile seizure (FS). The present study addresses two factors that were previously identified as predictors of recurrent FS in previous reports: maximum temperature and duration of fever prior to the initial FS. Methods: Children aged 6 months–6 years with an initial simple FS were eligible for the study. The interview included questions about the child's illness, family history of seizures, and other exposure information. In particular, they were asked about the duration of recognized fever prior to the seizure. After the initial interview, parents were called every 3–4 months to ascertain whether any further seizures had occurred and the circumstances under which such seizures occurred. Follow up ≥3 years was attempted for all children. Statistical analysis was done with χ² test, Fisher's exact test, Mann–Whitney U‐tests and logistic regression analysis. Results: Five of 92 children (5.4%) experienced unprovoked seizures and were considered part of an epilepsy group. In four of these five patients, the duration of recognized fever prior to FS fell more than ±2.5 SD outside the distribution for the non‐epilepsy group. Either an unusually short or long recognized fever prior to the initial FS was associated with an increased risk of unprovoked seizures. Conclusions: The duration of recognized fever appears to provide useful information about the risk for the later development of epilepsy.     

Evaluating and treating the child with a febrile seizure

Approximately 3% to 5% of children will experience a febrile seizure before the age of 5 years, with the peak onset in the second year of life. The majority of these seizures are “simple” (generalized, lasting less than 15 minutes, occurring only once in a 24-hour period), carry few risks of complications, and have excellent short- and long-term prognoses. Children with complex febrile seizures (focal features, lasting more than 15 minutes, occuring more than once in a 24-hour period) have higher rates of coexisting problems (electrolyte (disturbances and meningitis) and are at greater risk of recurrence and epilepsy than their counterparts With simple febrile seizures. A bacterial source for the fever is rarely found; a combination of host susceptibility in concert with viral trigger is believed to he responsible. Routine “screening tests” are unnecessary, and evaluation should be directed by the results of individual history and physical examination. Antipyretics have not been shown to decrease the incidence of recurrence in susceptible children. Oral and rectal diazepam have been shown to decrease recurrent seizures only in a select subset of children at high risk for recurrence.     

Low morbidity and mortality of status epilepticus in children

In an ongoing study of status epilepticus, 193 children with status epilepticus of varying causes have been followed up for a mean period of 13.2 months. Of these, 97 patients were recruited prospectively. The patients' ages ranged from 1 month to 18 years (mean, 5.0 years). The cause of the status epilepticus was classified as idiopathic in 46 cases, remote symptomatic in 45, febrile in 46, acute symptomatic in 45, and progressive neurologic in 11. The mortality and incidence of sequelae following status epilepticus was low and primarily a function of etiology. Seven children died within 3 months of having the seizure. New neurologic deficits were found in 17 (9.1%) of the 186 survivors. All of the deaths and 15 of the 17 sequelae occurred in the 56 children with acute or progressive neurologic insults. Only two of the 137 children with other causes sustained any new deficits (P less than .001). Duration of the status epilepticus affected outcome only within the acute symptomatic group (P less than .05). Neurologic sequelae occurred in 29% of infants younger than 1 year of age, 11% of children 1 to 3 years of age, and 6% of children older than 3 years of age. However, this was a reflection of the greater incidence of acute neurologic disease in the younger age groups. Within each cause, age did not affect outcome. Of the 193 children, 61 (32%) had a history of prior unprovoked seizures. Of the 125 surviving children with no history of prior unprovoked seizures, 37 (30%) had subsequent unprovoked seizures.(ABSTRACT TRUNCATED AT 250 WORDS)     

Iron deficiency as a risk factor for first febrile seizure

We conducted this study to determine the role of iron deficiency as a risk factor for first febrile seizure in children. Fifty children between 6 months to 6 years with first febrile seizure (Cases) and 50 children with febrile illness but without convulsions (Controls) were enrolled from the pediatric ward of a tertiary care hospital. Iron deficiency was determined by estimation of hemoglobin, red blood cell indices and serum ferritin. The mean serum ferritin level (μg/L) was significantly low in Cases (31.9 ± 31.0) as compared to Controls (53.9 ± 56.5) with P = 0.003. Iron deficiency could be a potential risk factor for febrile seizure in children.     

Low risk of seizure recurrence after early withdrawal of antiepileptic treatment in the neonatal period.

The risk of seizure recurrence within the first year of life was evaluated in infants with neonatal seizures diagnosed with a combination of clinical signs, amplitude-integrated electroencephalogram (EEG) monitoring, and standard EEG. Fifty eight of 283 (4.5%) neonates in tertiary level neonatal intensive care had seizures. The mortality in the infants with neonatal seizures was 36.2%. In 31 surviving infants antiepileptic treatment was discontinued after one to 65 days (median 4.5 days). Three infants received no antiepileptic treatment, two continued with prophylactic antiepileptic treatment. Seizure recurrence was present in only three cases (8.3%)--one infant receiving prophylaxis, one treated for 65 days, and in one infant treated for six days. Owing to the small number of infants with seizure recurrence, no clinical features could be specifically related to an increased risk of subsequent seizures. When administering antiepileptic treatment, one aim was to abolish both clinical and electrographical seizures. Another goal was to minimise the duration of treatment and to keep the treatment as short as possible. It is suggested that treating neonatal seizures in this way may not only reduce the risk of subsequent seizure recurrence, but may also minimise unnecessary non-specific prophylactic treatment for epilepsy.     

热性惊厥复发危险因素与预后分析

目的研究热性惊厥患儿的复发危险因素及预后情况.方法结合98例热性惊厥患儿的临床及脑电图资料,研究其复发、转为癫和出现智力障碍及行为异常的情况.结果复发共52例(53.0%),复发危险因素与惊厥家族史、初次发作体温＜38.5℃、初次发作年龄＜1岁及复杂型热性惊厥有关(P＜0.01);热性惊厥转为癫共20例(20.4%),转为癫的危险因素与复杂型热性惊厥、初次发作年龄＜1岁、热性惊厥反复发作有关(P＜0.01);发生智力障碍及行为异常2例(2.0%),说明热性惊厥患儿绝大部分预后较好,智力低下及行为障碍发生率低.结论对有复发危险因素及转为癫危险因素的患儿,应密切随访,采取适当的干预措施.     

地西泮预防热性惊厥复发的疗效与安全性的系统评价和Meta分析

目的 采用Meta分析方法评价间歇使用地西泮预防热性惊厥（FS）复发的疗效及安全性。方法 计算机检索The Cochrane Library(2014年第7期)、PubMed、EMBASE、中国生物医学文献数据库、中国知网、维普中文期刊数据库和万方数据库,收集使用地西泮预防儿童FS复发的RCT文献,检索时限均为建库至2014年7月。由2位研究者按照纳入与排除标准筛选文献,提取数据和评价纳入文献的方法学质量。根据FS复发危险因素行亚组分析。采用RevMan 5.2软件进行Meta分析。结果 9篇RCT文献（n=1 578）进入Meta分析。纳入文献的随机序列产生、分配隐藏和盲法为高度偏倚,选择性报告研究结果、结果的完整性和其他偏倚来源为低度偏倚。①随访6个月地西泮组与对照组FS复发率差异无统计学意义,RR=0.62(95% CI：0.34~1.13), P=0.12;RD=-0.07(95%CI:-0.16~0.02);对FS复发危险因素行亚组分析：地西泮低危险亚组与对照组FS复发率差异无统计学意义,RR=0.69（95%CI：0.40~1.21),P=0.20,中危险亚组与高危险亚组FS复发率显著低于对照组,RR分别为0.31（95%CI：0.15~0.62)和0.24（95%CI：0.10~0.56）。②随访12和24个月地西泮组FS复发率显著低于对照组,RR分别为0.59（95%CI：0.38~0.91）和0.54(95%CI:0.37~0.78);RD分别为-0.12(95%CI：-0.22~-0.02)和-0.17(95%CI:-0.27~-0.07)。对FS复发危险因素行亚组分析：地西泮低危险亚组与对照组FS复发率差异无统计学意义,RR分别为0.81(95% CI:0.47~1.42)和0.71（95%CI：0.45~1.11),中危险亚组与高危险亚组FS复发率显著低于对照组,12个月： RR分别为0.39(95% CI:0.20~0.75)和0.27(95%CI:0.13~0.58);24个月：RR分别为0.43(95%CI：0.24~0.77)和0.35(95%CI：0.19~0.62)。③纳入文献均无地西泮严重不良事件的报告。结论 地西泮间歇给药可有效降低12和24个月FS复发率,对于FS中高危人群显示出较好疗效的趋势,但仍需进一步补充研究明确。