When Seizures Return

This one isn’t precisely hot-off-the press, but, in having just discovered it, it’s hot to me!

This study aims to inform the guidance we provide to families after a child presents with a first-time, unprovoked seizure. Interestingly enough, the data for this analysis is dredged back up from a prospective cohort study from 2005 to 2007, in which patients with first-time seizures were being evaluated for abnormal neuroimaging. However, following discharge from the hospital or Emergency Department, patients also received short- and long-term telephone follow-up.

There were 475 patients enrolled in the original study, and differing numbers were appropriate for inclusion at their various timeframes of follow-up, depending on whether anti-epileptic therapy was started, or whether follow-up could be obtained. All told, seizure recurrence rates were:

  • 48 hours – 21/38 (5.4%)
  • 14 days – 51/359 (14.2%)
  • 4 months – 102/335 (30.4%)

These are extremely non-trivial numbers, and they surprised me. Risk facotrs associated with increased seizure incidence were recurrent seizures at initial presentation, younger age (<3 years), and presence of focal neurologic findings on initial examination. Regardless, however, even absent any of these predictors, the incidence of subsequent seizure is certainly high enough parents should be counseled they ought arrange for prompt neurology evaluation in follow-up.

“Early Recurrence of First Unprovoked Seizures in Children”

https://www.ncbi.nlm.nih.gov/pubmed/29105207

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