The Risk of Seizure Recurrence Following a First Unprovoked Seizure in Childhood: An Extended Follow-Up

OBJECTIVES: Whether or not to treat children following a first unprovoked seizure has been a controversial issue. Results of long-term outcome after a first unprovoked seizure in children are extremely variable. Untoward effects of long-term AEDs(antiepileptic drugs), especially cognitive dysfunction and behavioral problems, are important especially in developing children. For these reasons, informations with regard to the recurrence rate following a first unprovoked seizure and the predictors of risk factor of seizure recurrence are important for the decision of rational AEDs treatment. Therefore, we performed a long-term prospective study to evaluate the recurrence risk and risk factors after a first unprovoked seizure in children. METHODS: From Jun. 1994, 409 children with a first unprovoked seizure were followed prospectively from the day of the first seizure to Jul. 2004 for a mean of 41 months. The cumulative rate and risk factors of seizure recurrence (EEG finding, etiology of seizure, onset age, seizure occurring while asleep, presence of Todd's paresis, abnormal neurodevelopmental status, family history of seizure, previous febrile convulsion, duration of seizure, number of seizure in 24 hours, and type of seizure) were analyzed by Kaplan-Meier survival analysis and Cox's proportional hazard model. RESULTS: 177 children(43.3%) experienced seizure recurrence. The cumulative risk of recurrence was 28.5%, 38.6%, 46.3%, 51.5%, 53.6% at 6 months, 1, 2, 5, and 8 respectively. The mean duration of seizure recurrence after a first seizure was 7.6 months; 63.3% of recurrences within 6 months, 96% within 2 years, and only 2 recurrences 5 years after first seizure. In this study, etiology of epileptic seizure (cryptogenic and remote symptomatic) and EEG abnormality were the only statistically significant risk factors. Cumulative risk of seizure recurrence was 34.5% at 5 years in children with an idiopathic etiology and normal EEG. In children with cryptogenic first seizure, age of onset (older than 3 years), abnormal EEG finding and a history of previous complex febrile conversion were associated with high recurrence. CONCLUSION: About a half of children with first unprovoked seizure have not experienced recurrence. Children with a first seizure of idiopathic etiology and normal EEG have a particularly favorable prognosis. These results suggest that children with first unprovoked seizure should not be treated routinely even though they have risk factors for recurrence. Whenever AEDs treatment are considered, the decision need to be individualized and based on the risk and benefit ratio.

Author dc:creator

• 김, 병주

Contributors dc:contributor

• 김, 성환
• 대학원 의학과
• 200024425

• Unprovoked seizure
• Recurrence risk
• EEG
• Etiology of seizure

Language dc:language

ko

Identifier

http://dcoll.ajou.ac.kr:9080/dcollection/jsp/common/DcLoOrgPer.jsp?sItemId=000000000181
000000000181

OAI identifier oai:identifier

oai:repository.ajou.ac.kr:201003/1481