Evaluation and management of the first unprovoked seizure in children: Single-center experience first unprovoked seizure in children

Abstract

Aim: We aimed to evaluate clinical and laboratory features in children who presented unprovoked seizure for the first time and also to determine possible risk factors for seizure recurrence. 

Materials and Methods: A total of 219 patients (113 female, 106 male) presented with first unprovoked seizure were included in the study. Demographic, clinical findings (type and duration of seizures, seizure recurrence, antiseizure drugs), neuroimaging findings and electroencephalography (EEG) results were recorded retrospectively.

Results: Median age of the patients was 30 months (IQR 12-66). A history of birth hypoxia and/or phototherapy and family history of epilepsy were present in 21% and 17.4%, respectively. Generalized seizures were the most common seizure type (42%), with a predominance at <2 years of age compared to the other age groups (p=0,007).  Seizures recurred in 28% of the patients. Abnormal EEG findings were detected in 33.8% and most of them were >2 years of age (p<0,01). Brain MRI abnormalities were detected in 19% and recurrence was higher in the patients with abnormal MRI (p<0,001). No correlation was found between seizure recurrence and EEG abnormality. In focal seizures, the rate of seizure recurrence was higher than generalized seizures. Antiseizure therapy was initiated in 44% of the patients. Drug switch were required in 22 patients due to side effects. Etiology was determined in nearly half of the patients.

Conclusion: In our study, abnormal brain MRI were determined as possible risk factors for seizure recurrence. Comprehensive etiological investigation should be considered following the first episode of unprovoked seizures, especially in patients under two years.