RISK OF RECURRENCE AFTER A FIRST NON PROVOKED SEIZURE IN CHILDREN

Objectives: To determine the risk factors for seizure recurrence in children who experienced a first non provoked seizure.

Methods: One-hundred and fifteen children aged from 1 to 14 years (mean:8.8y) whose neurological exam was normal and who presented a first non provoked seizure were followed-up from 1 to 5 years (mean:2.2y). Potential risk factors analyzed included age, gender, type and duration of seizure, family history for epilepsy, EEG, and neuroimaging.

Results: There were 73 males and 42 females. In 54, the seizures were generalized tonic-clonic, partial with secondary generalization in 42, and partial in 19. In 28 cases the seizures lasted more than 20 minutes. Positive family history for epilepsy in first degree relatives was found in 55 cases. Abnormal EEG occurred in 27/108 patients. Abnormal imaging was detected in 9/84. Recurrence occurred in 51 patients (44.5%). From these, 62.75% occurred in the first 6 months and 80.4% within 12 months. The only risk factor statistically significant was abnormal EEG (p<0.05).

Conclusion: In our series the estimated risk of recurrence after a non provoked seizure is high achieving almost half of the cases. Two-thirds of these occur in the first 6 months. Abnormal EEG which was present in 25% of the cases was the only significant factor for recurrence. However, we do not think that these patients deserve prophylactic treatment with anti epileptic drugs for about 1/3 of the patients who did not relapsed presented an abnormal EEG.