Abstract:Objective To investigate the recurrence rate and risk factors of spontaneous symptomatic epileptic seizures after the first episode in infants and young children. Methods The clinical data of infants and young children who experienced the first episode of spontaneous symptomatic epileptic seizures between April 2009 and April 2011 in Suzhou Children's Hospital were collected. Follow-up visits were performed once every 1-3 months, and the followup time was 1-60 months. The Kaplan-Meier method and Cox proportional hazards model were applied to calculate the recurrence rate of spontaneous symptomatic epileptic seizures and analyze the risk factors for seizure recurrence. Results Sixty-three children experiencing a first episode of spontaneous symptomatic epileptic seizures were enrolled. Within 5 years after the first episode, 43 children experienced the recurrence of spontaneous symptomatic epileptic seizures, with a 5-year cumulative recurrence rate of 69.4%. Among all recurrent cases, 86% experienced recurrence within 1 year after the first episode. The multivariate analysis with the Cox proportional hazards model showed that epileptiform discharges on electroencephalography were the independent risk factor for recurrence of spontaneous symptomatic epileptic seizures (HR=5.349, 95%CI: 2.375-12.048). Conclusions The recurrence rate of spontaneous symptomatic epileptic seizures after the first episode is high in infants and young children. Epileptiform discharges on electroencephalography are the independent risk factor for the recurrence, and thus it is suggested to perform antiepileptic therapy for these children.
ZHANG Li-Ya,TANG Ji-Hong,LI Yan. Risk factors for 5-year recurrence of spontaneous symptomatic epileptic seizures in infants and young children[J]. CJCP, 2016, 18(4): 301-305.
Fisher RS, Acevedo C, Arzimanoglou A, et al. ILAE official report: a practical clinical definition of epilepsy[J]. Epilepsia, 2014, 55(4): 475-482.
[3]
Guidelines for epidemiologic studies on epilepsy. Commission on Epidemiology and Prognosis, International League Against Epilepsy[J]. Epilepsia, 1993, 34(4): 592-596.
[4]
Proposal for revised classification of epilepsies and epileptic syndromes. Commission on Classification and Terminology of the International League Against Epilepsy[J]. Epilepsia, 1989, 30(4): 389-399.
[5]
Beghi E, Berg A, Carpio A, et al. Comment on epileptic seizures and epilepsy: definitions proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE)[J]. Epilepsia, 2005, 46(10): 1698-1699.
[6]
Beghi E. AED discontinuation may not be dangerous in seizurefree patients[J]. J Neural Transm, 2011, 118(2): 187-191.
[7]
Schmidt D. AED discontinuation may be dangerous for seizurefree patients[J]. J Neural Transm, 2011, 118(2): 183-186.
[8]
Ramos-Lizana J, Aguirre-Rodriguez J, Aguilera-Lopez P, et al. Recurrence risk after a first remote symptomatic unprovoked seizure in childhood: a prospective study[J]. Dev Med Child Neurol, 2009, 51(1): 68-73.
[9]
Ramos Lizana J, Cassinello Garcia E, Carrasco Marina LL, et al. Seizure recurrence after a first unprovoked seizure in childhood: a prospective study[J]. Epilepsia, 2000, 41(8): 1005-1013.
[10]
Musicco M, Beghi E, Solari A, et al. Treatment of first tonicclonic seizure does not improve the prognosis of epilepsy. First Seizure Trial Group (FIRST Group)[J]. Neurology, 1997, 49(4): 991-998.
[11]
Berg AT, Shinnar S. The risk of seizure recurrence following a first unprovoked seizure: a quantitative review[J]. Neurology, 1991, 41(7): 965-972.
[12]
Ekici B, Aydinli N, Aydin K, et al. Epilepsy in children with periventricular leukomalacia[J]. Clin Neurol Neurosurg, 2013, 115(10): 2046-2048.
[13]
Kerkhof M, Vecht CJ. Seizure characteristics and prognostic factors of gliomas[J]. Epilepsia, 2013, 54 (Suppl 9): 12-17.
[14]
Hsu CJ, Weng WC, Peng SS, et al. Early-onset seizures are correlated with late-onset seizures in children with arterial ischemic stroke[J]. Stroke, 2014, 45(4): 1161-1163.
[15]
Shinnar S, Berg AT, Moshe SL, et al. The risk of seizure recurrence after a first unprovoked afebrile seizure in childhood: an extended follow-up[J]. Pediatrics, 1996, 98(2 Pt 1): 216-225.
[16]
Goldberg I, Neufeld MY, Auriel E, et al. Utility of hospitalization following a first unprovoked seizure[J]. Acta Neurol Scand, 2013, 128(1): 61-64.
[17]
Gilbert DL, Buncher CR. An EEG should not be obtained routinely after first unprovoked seizure in childhood[J]. Neurology, 2000, 54(3): 635-641.
[18]
Berg AT, Arts W, Boulloche J, et al. An EEG should not be obtained routinely after first unprovoked seizure in childhood[J]. Neurology, 2000, 55(6): 898-899.
[19]
Dlugos DJ. An EEG should not be obtained routinely after first unprovoked seizure in childhood[J]. Neurology, 2000, 55(6): 898-899.
[20]
Arthur TM, Degrauw TJ, Johnson CS, et al. Seizure recurrence risk following a first seizure in neurologically normal children[J]. Epilepsia, 2008, 49(11): 1950-1954.
[21]
Yigit O, Eray O, Mihci E, et al. EEG as a part of the decisionmaking process in the emergency department[J]. Eur J Emerg Med, 2013, 20(6): 402-407.