Seizure recurrence risk following a first seizure in neurologically normal children

• Published in: Epilepsia (Copenhagen) Vol. 49; no. 11; pp. 1950 - 1954
• Main Authors: Arthur, Todd M., DeGrauw, Ton J., Johnson, Cynthia S., Perkins, Susan M., Kalnin, Andrew, Austin, Joan K., Dunn, David W.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-11-2008; Wiley-Blackwell
• Subjects: Adolescent; Anticonvulsants. Antiepileptics. Antiparkinson agents; Biological and medical sciences; Brain - physiopathology; Child; Children; EEG; Electroencephalography; Epilepsy; Female; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Humans; Incidence; Magnetic Resonance Imaging; Male; Medical sciences; MRI; Nervous system (semeiology, syndromes); Neurology; Neuropharmacology; Pharmacology. Drug treatments; Prospective Studies; Recurrence; Risk Factors; Seizures - epidemiology; Seizures - physiopathology; Human; Recurrence; Nervous system diseases; MRI; Epilepsy; EEG; Electrophysiology; Electroencephalography; Nuclear magnetic resonance imaging; Cerebral disorder; Convulsion; Central nervous system disease; Risk factor; Children; Neurological disorder; Child
• ISSN: 0013-9580; 1528-1167
• DOI: 10.1111/j.1528-1167.2008.01775.x

Summary
Purpose:  To define seizure recurrence rates in normal children who had had a single seizure and to define electroencephalography (EEG) or magnetic resonance imaging (MRI) utility in predicting seizure recurrence.
Methods:  We studied 150 children (6 to 14 years) with a first afebrile, unprovoked seizure. Inclusion criteria were: Normal physical and neurological examination, undergone EEG and MRI studies of the brain, and followed for at least 27 months. These children participated in an ongoing prospective study of new onset seizures in childhood.
Results:  The seizure recurrence rate was 66.4%. An abnormal EEG had no association with seizure recurrence at 9, 18, or 27 months (p = 0.1806, p = 0.2792, and p = 0.2379, respectively). A “significant” MRI abnormality, which occurred in 16.0% of patients, was associated with an increased seizure recurrence risk at 9 months (p = 0.0389) but not at 18 or 27 months.
Discussion:  EEG findings poorly predict recurrence after a single seizure. The high rate of MRI abnormalities suggests that MRI may need consideration as a routine test to evaluate epilepsy in normal children.