Epidemiology of first convulsive seizures in children

Abstract

Objective: Aetiologies of first-ever convulsive epileptic seizures may be diverse, not all leading to diagnosis of epilepsy. We aimed to describe the epidemiology of first convulsive seizures in children and to assess risk factors for recurrence, repeat admission to the ED and subsequent development of epilepsy. Methods: Retrospective chart review of all children who presented with a first-ever convulsive seizure to Padua Paediatric ED between 01.03.2011 and 29.02.2012, with a 4-year follow-up. Univariate and bivariate statistical analysis were used for data description. For definition and classification of seizures, epilepsies and epileptic syndromes the following documents were used: Commission, 1989; Commission, 1993; Chin, 2004; Beghi, 2010; Berg, 2010; Fisher, 2014; Bergamo, 2015. Results: During the 12-month study period, 182 children presented to the ED with convulsive epileptic seizures; 108 of these presented with first-ever episode. Seizure duration was <5 min in >75%, 5–30 min in 21.3% and >30 min in 1.9% only. Aetiologic classification at discharge was: febrile seizures (FS) (71.3%), remote symptomatic seizures (5.6%), benign seizures associated with gastroenteritis (4.6%), acute symptomatic seizures (2.7%), acute on remote symptomatic seizures (1.9%), presumed idiopathic epileptic seizure (1.9%), unknown (12%). “Unprovoked” seizures (“Un”S) were 19.5%. The 4-year risk of seizure recurrence was 37.9% (60% in the “Un”S group); EEG epileptiform discharges and “Un”S aetiology were risk-factors for recurrence. The 4-year risk of diagnosis of epilepsy was 13.6% (60% in the “Un”S group); risk factors were: focal seizures, EEG epileptiform discharges, age >6 years and “Un”S aetiology of the first seizure. Conclusions: Children presenting to ED with first-ever convulsive epileptic seizures represent an heterogeneous group: while most of these have FS with an excellent prognosis, patients with “Un”S have a high risk of both seizure recurrence and receiving diagnosis of epilepsy, especially in case of focal seizures, EEG epileptiform discharges and age >6 years.