THE FIRST UNPROVOKED, UNTREATED SEIZURE IN CHILDHOOD - A HOSPITAL-BASED STUDY OF THE ACCURACY OF THE DIAGNOSIS, RATE OF RECURRENCE, AND LONG-TERM OUTCOME AFTER RECURRENCE - DUTCH STUDY OF EPILEPSY IN CHILDHOOD

Objective-To assess the accuracy of the diagnosis of a first unprovoke d seizure in childhood, the recurrence rate within two years, the risk factors for recurrence, and the long term outcome two years after rec urrence. Methods-One hundred and fifty six children aged 1 month to 16 years after a first seizure, and 51 children with a single disputable event were followed up. The diagnosis of a seizure was confirmed by a panel of three child neurologists on the basis of predescribed diagno stic criteria. None of the children was treated after the first episod e. Results-Five children with a disputable event developed epileptic s eizures during follow up. The diagnosis did not have to be revised in any of the 156 children with a first seizure. The overall recurrence r ate after two years was 54%. Significant risk factors were an epilepti form EEG (recurrence rate 71%) and remote symptomatic aetiology and/or mental retardation (recurrence rate 74%). For the 85 children with on e or more recurrences, terminal remission irrespective of treatment tw o years after the first recurrence was >12 months in 50 (59%), <six mo nths in 22 (26%), and six to 12 months in 11 (13%) and unknown in two (2%). Taking the no recurrence and recurrence groups together, a termi nal remission of at least 12 months was present in 121 out of the 156 children (78%). Conclusions-The diagnosis of a first seizure can be ma de accurately with the help of strict diagnostic criteria. The use of these criteria may have contributed to the rather high risk of recurre nce in this series. However, the overall prognosis for a child present ing with a single seizure is excellent, even if treatment with antiepi leptic drugs is not immediately instituted.