Risk of seizure recurrence following a first unprovoked seizure in childhood: a prospective study

In a prospective study, 283 children who presented with a first unprovoked seizure were followed for a mean of 30 months from the time of first seizure. Subsequent seizures were experienced by 101 children (36%). The cumulative risk of seizure recurrence for the entire study group was 26% at 12 months, 36% at 24 months, 40% at 36 months, and 42% at 48 months. The cumulative risk of recurrence in the 47 children with a remote symptomatic first seizure was 37%, 53%, and 60% at 12, 24, and 36 months, respectively, compared with a cumulative risk of 24%, 33%, and 36% at 12, 24, and 36 months, respectively, in the 236 children who had had an idiopathic first seizure (P less than .01). In children with an idiopathic first seizure, the electroencephalogram was the most important predictor of recurrence. The cumulative risk of recurrence in the 81 children with abnormal electroencephalograms was 41%, 54%, and 56% at 12, 24 and 36 months, respectively, but only 15%, 23%, and 26% at 12, 24, and 36 months, respectively, in the 138 children with normal electroencephalograms (P less than .001). A history of epilepsy in a first-degree relative was a significant risk factor only in idiopathic cases with abnormal electroencephalograms. In children with a remote symptomatic first seizure, either a history of prior febrile seizures or the occurrence of a partial seizure were significant predictors of recurrence. Age at first seizure and duration of seizure did not affect recurrence risk in either the idiopathic or remote symptomatic group. A total of 84% of the children were not treated with antiepileptic drugs or were treated for less than 2 weeks. Only 9% were treated for longer than 3 months. Treatment did not affect the risk of recurrence. The results suggest that, even without treatment, the majority of children with a first unprovoked seizure will not experiment a recurrence. Children with an idiopathic first seizure and a normal electroencephalogram have a particularly favorable prognosis.     

Accidental epileptic seizures in children

The authors report a series of 71 children admitted to a general pediatric hospital for a first non febrile, non symptomatic seizure and observed for an average of 6 years and 5 months. Among these patients, 19 cases corresponded to an isolated unexplained seizure without paroxysmal E.E.G. abnormalities, which did not reappear without treatment in a mean follow-up period fo 5 years and 3 months. The typical features of these "accidental seizures" are compared with other types of epilepsy. Finally, these "accidental seizures" can be classified into 2 groups: atonic seizures in the young child (1-4 years) and partial seizures in older children. A statistical analysis was undertaken to define the risk factors for recurrence after the first epileptic attack. A low recurrence risk is expected for children between 1 to 4 years with atonic type of seizures without paroxysmal E.E.G. abnormalities while there is a high recurrence risk for children under 1 year with generalized seizures and paroxysmal E.E.G. intercritical abnormalities.     

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   

Effective short-term diazepam prophylaxis in febrile convulsions

The efficacy of short-term diazepam prophylaxis in febrile convulsions was evaluated in a prospective, controlled study. A total of 289 consecutive children admitted with their first febrile seizure were randomized into two groups. One group received short-term prophylaxis for 18 months with rectally administered diazepam in solution whenever the temperature was greater than or equal to 38.5 degrees C. The control group received no prophylaxis, but diazepam rectally in the event of new seizures. The short-term prophylaxis, a mean of five doses of diazepam per child per year, afforded effective seizure control; the 18-month recurrence rate was reduced from 39% to 12% (P less than 0.001), the total number of recurrences from 77 to 23 (P less than 0.001), the long-lasting recurrences from 5.0% to 0.7% (P less than 0.05). The risk of subsequent epilepsy within the first 2 years was the same, regardless of receiving prophylaxis (3%) or not (3%); it was low after simple febrile convulsions (no cases of epilepsy in 230 children) but considerable after complex febrile seizures (20%) or seizures associated with severe interictal EEG abnormalities (50%).     

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.     

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%).     

Antiepileptic drug withdrawal in childhood epilepsy: What are the risk factors associated with seizure relapse?

BackgroundIn recent years, several studies have been conducted to determine the risk of relapse after antiepileptic drug (AED) withdrawal: there is no general agreement on criteria that can predict safe discontinuation or seizure recurrence.AimsTo evaluate prospectively the relapse rate of epilepsy associated to AED withdrawal in epileptic children and to determine the risk factors of seizure recurrence.MethodsOne hundred-sixty-eight children with epilepsy who were seizure-free for at least 2 years were enrolled and all children were proposed to stop AED treatment and were followed. In all children electroencephalograms (EEGs) were performed before the withdrawal of AEDs and after discontinuation of the treatment.ResultsA total of 48 (28.6%) children relapsed; half of these patients relapsed while reducing the AED dose and the other half after the AED was withdrawn; after 2 years without AEDs, the risk of relapse was very low. Data evaluated by multivariable analysis showed that the children receiving polytherapy before AED withdrawal, having a history of febrile seizures and suffering from multiple seizure types relapsed more frequently. The presence of abnormal post-withdrawal EEG recordings was associated with a higher risk of seizure recurrence.ConclusionsEpileptic children, after a seizure-free period of 2 years, have a low risk of seizure recurrence. The potential risk factors of relapse, are multiple seizure types previous polytherapy, history of febrile seizures and abnormalities in post-withdrawal EEG.     

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.     

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.     

Resective epilepsy surgery in childhood: the Dutch experience 1992-2002.

PURPOSE: We present the outcome of resective epilepsy surgery in 69 pediatric patients who participated in the Dutch Collaborative Epilepsy Surgery Program (DCESP) between 1992 and 2002 with special emphasis on long-term follow-up. METHODS: Sixty-nine children (aged 3 months to 17 years) operated on before 2003 were included in this study (34 temporal resections (49%), 17 extra-temporal resections (24%) and 19 hemispherectomies (27%)). Engel classification was used to assess seizure outcome annually. Cognitive outcome was assessed if possible. Two telephone surveys were carried out with an interval of 2(1/2) years to obtain data on seizure frequency, use of AEDs and on aspects op psychosocial development. Kaplan-Meier survival curves were constructed to assess recurrence of seizures after initial postsurgical seizure freedom, based on both telephone surveys. RESULTS: Seventy percent scored Engel 1, 18% Engel 2, 6% Engel 3 and 6% Engel 4 at the time of the first telephone survey (2(1/2) years later: 77% Engel 1, 8% Engel 2, 12% Engel 3 and 3% Engel 4). Temporal resections were associated with the best seizure outcome (Engel 1 74% and 82%). AEDs could be withdrawn successfully in 53% of patients at time of the last follow-up. No negative impact on cognition was found. The first long-term follow-up (mean 4.5 years after surgery) measurement showed recurrence of seizures after initial seizure freedom in 17%. At time of the second long-term follow-up measurement (mean 7.5 years after surgery) this percentage had increased to 21%. CONCLUSIONS: Our results support previous reports that surgery for intractable epilepsy in pediatric patients can be safely performed with satisfactory long-term results. Best results are attained in temporal resections.     

Epilepsy in newborns with tuberous sclerosis complex

BackgroundEpilepsy affects up to 90% of TSC patients and majority of them have seizure at the age of 3–5 months, after a period of latent epileptogenesis, but some develop epilepsy earlier.AimsThe aim of this work was to identify incidence, clinical characteristics, and risk factors for neonatal onset of epilepsy in a large cohort of TSC patients.MethodsA retrospective review of medical data of 421 TSC patients was performed. Patients who developed epilepsy within first 4 weeks of life were included in the study. Clinical and treatment data, EEG, MRI, and genetic analyses were assessed.ResultsEpilepsy was present in 366 (86.9%) patients. Twenty-one (5.7%) developed epilepsy as newborns. Mean follow-up was 44.86 (6–170) months. Six patients were seizure free and 15 had drug-resistant seizures at the end of follow-up. Mental retardation was found in 81% of patients. In 11 (52.4%) patients brain MRI revealed large malformations of cerebral cortex, meeting the criteria for focal cortical dysplasia (FCD). FCD was revealed in both TSC1 and TSC2 mutation cases. Other risk factors for neonatal epilepsy included: perinatal complications and congenital SEGAs. Presence of FCD was associated with more severe epilepsy and worse neuropsychological outcome. Epilepsy surgery resulted in improvement in seizure control.ConclusionsNeonatal onset of epilepsy in TSC is frequently associated with large malformations of cerebral cortex. Patients with FCD are at high risk of severe drug-resistant epilepsy and poor neuropsychological outcome. Early epilepsy surgery may be beneficial and should be considered in such cases.     

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.     

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.     

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.     

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.     

228例儿童癫痫停药后复发的相关因素分析

目的：　通过对临床已获控制并停药随访的癫痫患儿复发情况的分析,总结并讨论与复发有关的因素。方法：　回顾性分析228例临床已获控制并停药随访的癫痫患儿的临床资料。结果：　 228例患儿中51例复发(22.4%),其中92.2%于停药后5年内复发。与复发相关的因素有:起病年龄、伴有神经功能障碍、治疗前发作频率、治疗的早晚、控制期的长短及癫痫的类型(P<0.05)。与复发无关的因素有:达控时间的长短、停药年龄、性别及癫痫家族史(P>0.05)。结论：　对伴有复发危险因素的癫痫患儿应适当延长治疗和随访时间。不伴有以上相关因素的癫痫患儿,在经过正规的治疗和停药以后,可以取得比较满意的效果     

Vagus nerve stimulation for partial and generalized epilepsy from infancy to adolescence

Object Vagus nerve stimulation (VNS) is approved by the FDA for the treatment of partial epilepsy in patients older than 12 years. Authors of the current study performed a large retrospective analysis and comparison of VNS outcomes in children with an age ≥ and < 12 years, including those with partial and generalized epilepsy. Methods A retrospective review of the records of pediatric patients (age < 18 years) who had undergone primary VNS system implantation between 2001 and 2010 by a single pediatric neurosurgeon was undertaken. Considered data included demographics, epilepsy type (partial vs generalized), seizure frequency, seizure duration, postictal period duration, and antiepileptic medication use. Results One hundred forty-six patients (49% female) were followed up for a mean of 41 months after VNS implantation. Thirty-two percent of patients had partial epilepsy and 68% had generalized epilepsy. After VNS system implantation, seizure frequency was reduced in 91% of patients, seizure duration in 50%, postictal period in 49%, and antiepileptic medication use in 75%. There was no significant difference in age, sex, or duration of follow-up according to epilepsy type. Neither was there any significant difference in seizure frequency reduction, seizure duration, postictal period, medication use, overall clinical improvement, or improvement in quality of life based on an age ≥ or < 12 years or epilepsy type. Conclusions Vagus nerve stimulation reduced both seizure frequency and antiepileptic medication use in the majority of pediatric patients regardless of sex, age cohort, or epilepsy type. Vagus nerve stimulation also reduced seizure duration and postictal period in approximately half of the pediatric patients. Contrary to expectation, children with partial epilepsy do not benefit from VNS at higher rates than those with generalized epilepsy.     

Circulating neural antibodies in unselected children with new-onset seizures

Objective

The role of autoimmunity and neural antibodies is increasingly recognized in different forms of seizures and epilepsy. Their prevalence in new-onset epilepsy has also recently been the focus of several clinical cohorts in the adult and pediatric population, with positive titers in 10–11% of cases. Our aim was to determine the seropositivity at the first seizure onset in a non-selective group of children.