Last modified: 2018-09-09
Abstract
BACKGROUND: A first unprovoked seizure is a frightening event for the parents of healthy children, a situation not easy to handle even by the emergency physician. Prognosis data are heterogeneous1; global epilepsy drug-resistance rates up to 30%. We aimed to a presentation-vs-prognosis comparison.
METHODS: We retrospectively reviewed all neurologically normal children (1 mth-16 yrs) who presented to our Italian hospital for an unprovoked seizure, January 2004-December 2015. Clinical, EEG and Neuroimaging features at onset were collected. Patients were divided by age (infant <2, child 2-12, adolescent >12 yrs) and circadian onset distribution. Initial diagnosis based on such data was confronted with a two-year minimum follow-up.
RESULTS: Of 321 patients, 151 (47%) received antiepileptic treatment, 89/151 still taking it at follow-up. Fourteen ILAE-defined drug-resistant patients responded to more than two drugs, 3 to ketogenic diet or surgery and only 15 proved drug refractory. Age and sleep/wakefulness state at onset, along with initial electroclinical features, correctly oriented toward the final epileptic classification of most cases in each age group.
CONCLUSIONS: A first unprovoked seizure in healthy children is a devastating experience for the family, but the eventual prognosis in western countries is generally good. Only half of our patients requested drug treatment and the rate of thoroughly intractable epilepsy was low (4%). We suggest that correctly aimed analysis of some initial features may yield a prompt prognostic and counseling value in most patients.
1. Arthur TM et al. Seizure recurrence risk following a first seizure in neurologically normal children. Epilepsia. 2008;49(11):1950–4.