Neuropediatrics 2006; 37 - THP77
DOI: 10.1055/s-2006-945900

DIAGNOSES IN CHILDREN REFERRED TO A TERTIARY CARE, FIRST SEIZURE CLINIC

L Hamiwka 1, N Singh 1, J Niosi 1, E Wirrell 1
  • 1Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada

Objectives: To determine (a) the range of diagnoses presenting to a first seizure clinic, and (b) the seizure type, syndrome, etiology and prevalence of prior seizures in those presenting with epileptic events.

Methods: Between 01/01/2004 and 30/08/2005, 127 children were seen in a First Seizure Clinic at the Alberta Children's Hospital by one of two epileptologists. Inclusion criteria were age >1 month and an unprovoked event suggestive of seizure. Data collected included referring physician specialty, child's age, gender, developmental status and clinical diagnosis of epileptologist (non-epileptic vs. epileptic). For those with epileptic events, seizure type, syndrome (if identifiable), presumed etiology (idiopathic, cryptogenic, symptomatic), presence of prior afebrile and febrile seizures, presence and type of provoking factors, family history of epilepsy, pre/perinatal complications and EEG results were recorded.

Results: The diagnosis was epileptic in 94 (74%), nonepileptic in 31 (24%) and unclassifiable in 2 (2%). Specialists were no more likely than generalists to refer true epileptic events (75% vs. 58%, p<0.1). Gender ratio was 67M: 60F, and mean age at presentation was 8 years. Fifteen percent of children were developmentally delayed and neurological examination was abnormal in 11%. For those diagnosed with epileptic events, 32 presented with generalized (26 PGTC, 2 absence, 4 myoclonic) while 62 presented with partial onset seizures (2 partial simple, 27 partial complex, 28 SGTC). An epilepsy syndrome was identifiable in 15 cases. 28% experienced a prior seizure, which was unrecognized in 14%. Etiology was idiopathic in 35%, cryptogenic in 44% and symptomatic in 21%. An EEG was done in all children with seizures and was abnormal in 41%.

Conclusion: Nearly one quarter of children referred to a first seizure clinic had non-epileptic events. Of children presenting with true seizures, 28% had a history of a previous, often more subtle event.