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
- Hans Stroinka,
- Oebele F Brouwerb,
- Willem Frans Artsd,
- Ada T Geertsc,
- A C Boudewyn Peterse,
- Cees A van Donselaara
- aDepartment of Neurology, University Hospital Rotterdam-Sophia Children’s Hospital, Rotterdam The Netherlands, bDepartment of Neurology, Leiden University Medical Centre, Leiden, The Netherlands, cDepartment of Public Health, Erasmus University, Rotterdam, The Netherlands, dDepartment of Neurology, Westeinde Hospital and Juliana Children’s Hospital, The Hague, The Netherlands, eDepartment of Child Neurology, University Hospital Utrecht and Wilhelmina Children’s Hospital, Utrecht, The Netherlands
- Dr H Stroink, Department of Neurology, University Hospital Rotterdam-Sophia Children’s Hospital, PO Box 2060, 3000 CB Rotterdam, The Netherlands.
- Received 18 June 1997
- Revised 15 September 1997
- Accepted 25 September 1997
Abstract
OBJECTIVE To assess the accuracy of the diagnosis of a first unprovoked seizure in childhood, the recurrence rate within two years, the risk factors for recurrence, and the long term outcome two years after recurrence.
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 diagnostic criteria. None of the children was treated after the first episode.
RESULTS Five children with a disputable event developed epileptic seizures during follow up. The diagnosis did not have to be revised in any of the 156 children with a first seizure. The overall recurrence rate after two years was 54%. Significant risk factors were an epileptiform EEG (recurrence rate 71%) and remote symptomatic aetiology and/or mental retardation (recurrence rate 74%). For the 85 children with one or more recurrences, terminal remission irrespective of treatment two years after the first recurrence was >12 months in 50 (59%), <six months 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 terminal 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 made accurately with the help of strict diagnostic criteria. The use of these criteria may have contributed to the rather high risk of recurrence in this series. However, the overall prognosis for a child presenting with a single seizure is excellent, even if treatment with antiepileptic drugs is not immediately instituted.
