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
H. Stroink et al., 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, Journal of Neurology, Neurosurgery and Psychiatry, 64(5), 1998, pp. 595-600
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.