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Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1998 May;64(5):595–600. doi: 10.1136/jnnp.64.5.595

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 1, O Brouwer 1, W F Arts 1, A Geerts 1, A Peters 1, C A van Donselaar 1
PMCID: PMC2170103  PMID: 9598673

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.



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Selected References

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  1. Annegers J. F., Shirts S. B., Hauser W. A., Kurland L. T. Risk of recurrence after an initial unprovoked seizure. Epilepsia. 1986 Jan-Feb;27(1):43–50. doi: 10.1111/j.1528-1157.1986.tb03499.x. [DOI] [PubMed] [Google Scholar]
  2. Arts W. F., van Donselaar C. A., Stroink H., Peters A. C., Brouwer O. F. Follow-up of intractable seizures in childhood. Ann Neurol. 1991 Jul;30(1):115–115. doi: 10.1002/ana.410300122. [DOI] [PubMed] [Google Scholar]
  3. Berg A. T., Shinnar S. The risk of seizure recurrence following a first unprovoked seizure: a quantitative review. Neurology. 1991 Jul;41(7):965–972. doi: 10.1212/wnl.41.7.965. [DOI] [PubMed] [Google Scholar]
  4. Boulloche J., Leloup P., Mallet E., Parain D., Tron P. Risk of recurrence after a single, unprovoked, generalized tonic-clonic seizure. Dev Med Child Neurol. 1989 Oct;31(5):626–632. doi: 10.1111/j.1469-8749.1989.tb04048.x. [DOI] [PubMed] [Google Scholar]
  5. Camfield P. R., Camfield C. S., Dooley J. M., Tibbles J. A., Fung T., Garner B. Epilepsy after a first unprovoked seizure in childhood. Neurology. 1985 Nov;35(11):1657–1660. doi: 10.1212/wnl.35.11.1657. [DOI] [PubMed] [Google Scholar]
  6. Camfield P., Camfield C., Dooley J., Smith E., Garner B. A randomized study of carbamazepine versus no medication after a first unprovoked seizure in childhood. Neurology. 1989 Jun;39(6):851–852. doi: 10.1212/wnl.39.6.851. [DOI] [PubMed] [Google Scholar]
  7. Chadwick D. Epilepsy after first seizures: risks and implications. J Neurol Neurosurg Psychiatry. 1991 May;54(5):385–387. doi: 10.1136/jnnp.54.5.385. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Elwes R. D., Chesterman P., Reynolds E. H. Prognosis after a first untreated tonic-clonic seizure. Lancet. 1985 Oct 5;2(8458):752–753. doi: 10.1016/s0140-6736(85)90631-2. [DOI] [PubMed] [Google Scholar]
  9. Hart Y. M., Sander J. W., Johnson A. L., Shorvon S. D. National General Practice Study of Epilepsy: recurrence after a first seizure. Lancet. 1990 Nov 24;336(8726):1271–1274. doi: 10.1016/0140-6736(90)92960-p. [DOI] [PubMed] [Google Scholar]
  10. Hauser W. A., Rich S. S., Annegers J. F., Anderson V. E. Seizure recurrence after a 1st unprovoked seizure: an extended follow-up. Neurology. 1990 Aug;40(8):1163–1170. doi: 10.1212/wnl.40.8.1163. [DOI] [PubMed] [Google Scholar]
  11. Hopkins A., Garman A., Clarke C. The first seizure in adult life. Value of clinical features, electroencephalography, and computerised tomographic scanning in prediction of seizure recurrence. Lancet. 1988 Apr 2;1(8588):721–726. doi: 10.1016/s0140-6736(88)91535-8. [DOI] [PubMed] [Google Scholar]
  12. Pearce J. L., Mackintosh H. T. Prospective study of convulsions in childhood. N Z Med J. 1979 Jan 10;89(627):1–3. [PubMed] [Google Scholar]
  13. Shinnar S., Berg A. T., Moshe S. L., O'Dell C., Alemany M., Newstein D., Kang H., Goldensohn E. S., Hauser W. A. The risk of seizure recurrence after a first unprovoked afebrile seizure in childhood: an extended follow-up. Pediatrics. 1996 Aug;98(2 Pt 1):216–225. [PubMed] [Google Scholar]
  14. Shinnar S., Berg A. T., Moshé S. L., Petix M., Maytal J., Kang H., Goldensohn E. S., Hauser W. A. Risk of seizure recurrence following a first unprovoked seizure in childhood: a prospective study. Pediatrics. 1990 Jun;85(6):1076–1085. [PubMed] [Google Scholar]
  15. Shinnar S., Berg A. T., Ptachewich Y., Alemany M. Sleep state and the risk of seizure recurrence following a first unprovoked seizure in childhood. Neurology. 1993 Apr;43(4):701–706. doi: 10.1212/wnl.43.4.701. [DOI] [PubMed] [Google Scholar]
  16. THOMAS M. H. The single seizures: its study and management. J Am Med Assoc. 1959 Jan 31;169(5):457–459. doi: 10.1001/jama.1959.03000220037008. [DOI] [PubMed] [Google Scholar]
  17. van Donselaar C. A., Geerts A. T., Meulstee J., Habbema J. D., Staal A. Reliability of the diagnosis of a first seizure. Neurology. 1989 Feb;39(2 Pt 1):267–271. doi: 10.1212/wnl.39.2.267. [DOI] [PubMed] [Google Scholar]

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