A Clinical Study Of The Risk Of Recurrence After A First Unprovoked Seizure In Children

Objective To evaluate the risk of a first unprovoked seizure and analyze the potential predictors of recurrence.Methods Included in the study, 70 patients were enrolled if they had a first unprovoked seizure. The study was conducted in the department of neurology of Children Hospital affiliated to Soochow University between April, 2009 to April, 2010. All consecutive patients were followed up for 1 year for possible recurrence. No antiepileptic drug were accepted until a relapse was observed. Clinical features of patients attended after a first seizure were recorded, include patients' gender, age, positive family history, developmental status, presence of prior febrile seizures. The current seizure states were compared, include seizure type,duration of seizure, number of seizures, sleep state, Todd's paresis. Physical and neurological examination were performed in all patients, EEG and CT/MRI were undergoned as a routine test. Recurrence risk in the group was estimated by the Kaplan-Meier procedure. Univariate and multivariate analyses of the potential predictors of recurrence risk were performed for the group of patients attended after the first unprovoked seizure using the Cox proportional hazards model.Results 29 patients of the sample population experienced a second attack after 1 year, Kaplan-Meier estimate of the recurrence rate was 41%. The cumulative probability of a second attack at 1 month, 6 months, 1 year was 16%, 23%, 41%, respectively. Significant differences in several clinical features were found between patients attended for symptomatic seizures and idiopathic/cryptogenic seizures. In particular, the recurrence risk was 78% at 1 year for symptomatic seizures, compared with 36% for idiopathic/cryptogenic seizures. Cox univariate and multivariate analyses showed that symptomatic etiology increased the risk of recurrence, statistical analysis showed other significance predictors of recurrence included abnormal electroencephalogram, the occurrence of seizures during sleep, an age of 1month to 3 years.Conclusion The recurrence risk after the first unprovoked seizure depends on the inclusion criteria for enrolling patients. Several factors enable us to predict the recurrence risk after a first unprovoked seizure. The study help us determine the treatment of anti-epileptic and evaluate the prognosis.