Prognostic factors for recurrence of a first seizure during childhood

Winckler, Maria Isabel Bragatti; Rotta, Newra Tellechea

doi:10.1590/S0004-282X1997000500011

Abstracts

This study was designed with the objective of evaluating the chance of recurrence in our area and to answer questions regarding prognostic factors capable of helping in the management of the first seizure in childhood. One hundred and thirty six children from 1 month to 12 years of age seen at the Pediatric Emergency Division of Hospital de Clínicas de Porto Alegre because of a first seizure with or without triggering factors were included in the study. The follow-up included 121 children. We concluded that family history of seizures, presence of triggering factors at first event, seizure type, seizure duration and paroxysmal electroencephalographic abnormalities were predictive factors for seizure recurrence. The recurrence in this sample was 36.36% during the study. Cumulative recurrence risks were 14.88%, 23.14%, 28.93%, 33.06% and 35.54% to 3, 6, 9, 12 and 15 months, respectively.

seizures; child; prognoses; epilepsy

Este estudo foi elaborado com a finalidade de avaliar a possibilidade de recorrência e de responder a questões referentes a fatores prognósticos capazes de auxiliar no manejo da primeira crise convulsiva na infância. Foram incluídas 136 crianças com idades entre 1 mês e 12 anos atendidas no Setor de Emergência Pediátrica do Hospital de Clínicas de Porto Alegre por ocasião da primeira crise convulsiva, com ou sem fator desencadeante. Foram seguidas 121 crianças por 24 meses, concluindo-se que história familiar de crise convulsiva, existência de fatores desencadeantes na primeira convulsão, tipo de crise, duração da crise e alterações paroxísticas no primeiro eletrencefalograma foram fatores preditivos para a recorrência de crise convulsiva. A recorrência foi de 36,36% no tempo em que durou o estudo. Os riscos acumulados para recorrência nesta amostra foram 14,88%, 23,14%, 28,93%, 33,06% e 35,54% para 3, 6, 9, 12 e 15 meses, respectivamente.

convulsões; criança; prognóstico; epilepsia

Prognostic factors for recurrence of a first seizure during childhood

Estudo dos fatores prognósticos na recorrência da primeira crise convulsiva na infância

Maria Isabel Bragatti Winckler^I; Newra Tellechea Rotta^II

^IHospital de Clínicas de Porto Alegre (HCPA). Post-Graduation in Medicine: Pediatrics. Universidade Federal do Rio Grande do Sul (UFRGS). Porto Alegre, RS, Brazil: M.D., Pediatric Neurologist, Master in Pediatrics

^IIHospital de Clínicas de Porto Alegre (HCPA). Post-Graduation in Medicine: Pediatrics. Universidade Federal do Rio Grande do Sul (UFRGS). Porto Alegre, RS, Brazil: M.D., Pediatric Neurologist, Associate Professor of Neurology at UFRGS

ABSTRACT

This study was designed with the objective of evaluating the chance of recurrence in our area and to answer questions regarding prognostic factors capable of helping in the management of the first seizure in childhood. One hundred and thirty six children from 1 month to 12 years of age seen at the Pediatric Emergency Division of Hospital de Clínicas de Porto Alegre because of a first seizure with or without triggering factors were included in the study. The follow-up included 121 children. We concluded that family history of seizures, presence of triggering factors at first event, seizure type, seizure duration and paroxysmal electroencephalographic abnormalities were predictive factors for seizure recurrence. The recurrence in this sample was 36.36% during the study. Cumulative recurrence risks were 14.88%, 23.14%, 28.93%, 33.06% and 35.54% to 3, 6, 9, 12 and 15 months, respectively.

Key words: seizures, child, prognoses, epilepsy.

RESUMO

Este estudo foi elaborado com a finalidade de avaliar a possibilidade de recorrência e de responder a questões referentes a fatores prognósticos capazes de auxiliar no manejo da primeira crise convulsiva na infância. Foram incluídas 136 crianças com idades entre 1 mês e 12 anos atendidas no Setor de Emergência Pediátrica do Hospital de Clínicas de Porto Alegre por ocasião da primeira crise convulsiva, com ou sem fator desencadeante. Foram seguidas 121 crianças por 24 meses, concluindo-se que história familiar de crise convulsiva, existência de fatores desencadeantes na primeira convulsão, tipo de crise, duração da crise e alterações paroxísticas no primeiro eletrencefalograma foram fatores preditivos para a recorrência de crise convulsiva. A recorrência foi de 36,36% no tempo em que durou o estudo. Os riscos acumulados para recorrência nesta amostra foram 14,88%, 23,14%, 28,93%, 33,06% e 35,54% para 3, 6, 9, 12 e 15 meses, respectivamente.

Palavras-chave: convulsões, criança, prognóstico, epilepsia.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Acknowledgments - The authors thank Francisco T. Rotta, MD for valuable suggestions to this manuscript.

Aceite: 22-setembro-1997.

Dra. Maria Isabel Bragatti Winckler - Av. Benjamin Constant 1575 - 90550-005 Porto Alegre RS - Brasil.

1. Aicardi J. Epilepsy in children. Ed 2. New York: Raven Press 1994:1-543.
2. Berg AT, Shinnar S, Hauser WA, et al. A prospective study of recurrent febrile seizures. N Engl J Med 1992;327:1122-1127.
3. Berg AT, Shinnar S, Hauser WA, Leventhal JM. Predictors of recurrent febrile seizures: a metaanalytic review. J Pediatrics 1990;116:329-337.
4. Berg AT, Shinnar S, Shapiro ED, Salomon ME, Crain EF, Hauser WA. Risk factors for a first febrile seizure: a matched case-control study. Epilepsia 1995;36:334-341.
5. Berg AT, Shinnar S. The risk of seizure recurrence following a first unprovoked seizure: a quantitative review. Neurology 1991;41:965-972.
6. Berg AT, Testa FM, Levy SR, Shinnar S. The epidemiology of epilepsy: past, present and future. In Riggs J (ed) Neurologic clinics neuroepidemiology 1996;14:383-398.
7. Blom S, Heijbel J, Bergfors PG. Incidence of epilepsy in children: a follow-up study three years after the first seizure. . Epilepsia 1978;19:343-350.
8. Camfield P, Camfield C, Gordon K, Dooley J. What types of epilepsy are preceded by febrile seizures? a population - based study of children. Dev Med Child Neurol 1994;36:887-892.
9. Dodson E, Pellock JM. Epileptic syndromes. In Pediatric epilepsy: diagnosis and therapy. Ed 2. New York: Demos 1993:78-94.
10. Elwes RDC, Johnson Al, Reynolds EH. The course of untreated epilepsy. Br Med J 1988;297:948-950.
11. Esch A van, Steyerberg EW, Berger MY, Offringa M, Derksen-Lubsen G, Habbema JD. Family history and recurrence of febrile seizures. Arch Dis Child 1994;70:395-399.
12. Farwell JR, Blackner G, Sulzbacher S, Adelman L, Voeller M. First febrile seizures: characteristics of the child, the seizure, and the illness. Clin Pediatr 1994:263-267.
13. Forsgren L, Sidenvall R, Blomquist HK son, Heijbel J, Nyström L. Pre and perinatal factors in febrile convulsions. Acta Paed Scand 1991;80:218-225.
14. Gherpelli JLD, Paz JA, Leone CR, Ramos JLA, Diament AJ. Seizure recurrence in infants with neonatal convulsions. Arq Neuropsiquiatr 1992;50:31-36.
15. Hart YM, Sander JW, Johnson AL, Shorvon SD. National general practice study of epilepsy: recurrence after a first seizure. Lancet 1990;336:1271-1274.
16. Hauser WA. The prevalence and incidence of convulsive disorders in children. Epilepsia 1994;35:S1-S6.
17. Koelfen W, Maser P, Korinthenberg R. Risk of recurrent seizures after the first afebrile grand mal seizure in childhood. Monats Kinderheilkd 1991;139:639-642.
18. Komori H, Wada M, Eto M, Old H, Ainda K, Fujimoto T. Benign convulsions with mild gastroenteritis: a report of 10 recent cases detailing clinical varieties. Brain & Dev 1995;17:334-337.
19. Laubichler W, Ortner J, Plochl E, Wenger E. The status of afebrile infantile convulsions within the epilepsy spectrum: a follow-up of 55 patients. Nervenarzt 1992;63:741-745.
20. Livingston S. Comprehensive management of epilepsy in infancy, childhood and adolescence. Springfield: Charles Thomas, 1972.
21. Monetti VC, Granieri E, Casetta I et al. Risk factors for idiopathic generalized seizures: a population-based case control study in Copparo, Italy. Epilepsia 1995;36:224-229.
22. Murphy CC, Trevathan E, Yeargin-Allsopp M. Prevalence of epilepsy and epileptic seizures in 10-year-old children: results from the Metropolitan Atlanta developmental disabilities study. Epilepsia 1995;36:866-872.
23. Offringa M, Bossuyt PMM, Lubsen J et al. Risk factor for seizure recurrence in children with febrile seizures: a pooled analysis of individual patient data from five studies. J Pediatrics 1994;124:574-584.
24. Plõchl E, Laubichler W. Retrospektive Studie bei 160 Kindern mit Fieberkrämpfea Klin Pãdiatr 1992;204:16-20.
25. Shinnar S, Berg AT, Moshé S et al. Risk of recurrence following a first unprovoked seizure in childhood: a prospective study. Pediatrics 1990;85:1076-1085.
26. Shinnar S, Kang H, Berg AT, Goldensohn ES, Hauser WA, Moshé SL. EEG abnormalities in children with a first unprovoked seizure. Epilepsia 1994;35:471-476.
27. Silva CA da. Estudo prospectivo sobre o prognóstico de crises epilépticas recentes não provocadas ocorridas em crianças atendidas em um hospital universitário. Dissertação de Mestrado, Universidade Federal do Paraná. Curitiba, 1995.
28. Tsuboi T, Endo S, lida N. Long-term follow-up of a febrile convulsion cohort Acta Neurol Scand 1991;84:369-373.
29. Verity CM, Golding J. Risk of epilepsy after febrile convulsions: a national cohort study. Br Med J 1991;303:1373-1376.
30. Watts AE. The natural history of untreated epilepsy in a rural community in Africa. Epilepsia 1992;33:464-468.

Publication Dates

Publication in this collection
07 Oct 2010
Date of issue
1997

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Aicardi J. Epilepsy in children. Ed 2. New York: Raven Press 1994:1-543.

[2] 2. Berg AT, Shinnar S, Hauser WA, et al. A prospective study of recurrent febrile seizures. N Engl J Med 1992;327:1122-1127.

[3] 3. Berg AT, Shinnar S, Hauser WA, Leventhal JM. Predictors of recurrent febrile seizures: a metaanalytic review. J Pediatrics 1990;116:329-337.

[4] 4. Berg AT, Shinnar S, Shapiro ED, Salomon ME, Crain EF, Hauser WA. Risk factors for a first febrile seizure: a matched case-control study. Epilepsia 1995;36:334-341.

[5] 5. Berg AT, Shinnar S. The risk of seizure recurrence following a first unprovoked seizure: a quantitative review. Neurology 1991;41:965-972.

[6] 6. Berg AT, Testa FM, Levy SR, Shinnar S. The epidemiology of epilepsy: past, present and future. In Riggs J (ed) Neurologic clinics neuroepidemiology 1996;14:383-398.

[7] 7. Blom S, Heijbel J, Bergfors PG. Incidence of epilepsy in children: a follow-up study three years after the first seizure. . Epilepsia 1978;19:343-350.

[8] 8. Camfield P, Camfield C, Gordon K, Dooley J. What types of epilepsy are preceded by febrile seizures? a population - based study of children. Dev Med Child Neurol 1994;36:887-892.

[9] 9. Dodson E, Pellock JM. Epileptic syndromes. In Pediatric epilepsy: diagnosis and therapy. Ed 2. New York: Demos 1993:78-94.

[10] 10. Elwes RDC, Johnson Al, Reynolds EH. The course of untreated epilepsy. Br Med J 1988;297:948-950.

[11] 11. Esch A van, Steyerberg EW, Berger MY, Offringa M, Derksen-Lubsen G, Habbema JD. Family history and recurrence of febrile seizures. Arch Dis Child 1994;70:395-399.

[12] 12. Farwell JR, Blackner G, Sulzbacher S, Adelman L, Voeller M. First febrile seizures: characteristics of the child, the seizure, and the illness. Clin Pediatr 1994:263-267.

[13] 13. Forsgren L, Sidenvall R, Blomquist HK son, Heijbel J, Nyström L. Pre and perinatal factors in febrile convulsions. Acta Paed Scand 1991;80:218-225.

[14] 14. Gherpelli JLD, Paz JA, Leone CR, Ramos JLA, Diament AJ. Seizure recurrence in infants with neonatal convulsions. Arq Neuropsiquiatr 1992;50:31-36.

[15] 15. Hart YM, Sander JW, Johnson AL, Shorvon SD. National general practice study of epilepsy: recurrence after a first seizure. Lancet 1990;336:1271-1274.

[16] 16. Hauser WA. The prevalence and incidence of convulsive disorders in children. Epilepsia 1994;35:S1-S6.

[17] 17. Koelfen W, Maser P, Korinthenberg R. Risk of recurrent seizures after the first afebrile grand mal seizure in childhood. Monats Kinderheilkd 1991;139:639-642.

[18] 18. Komori H, Wada M, Eto M, Old H, Ainda K, Fujimoto T. Benign convulsions with mild gastroenteritis: a report of 10 recent cases detailing clinical varieties. Brain & Dev 1995;17:334-337.

[19] 19. Laubichler W, Ortner J, Plochl E, Wenger E. The status of afebrile infantile convulsions within the epilepsy spectrum: a follow-up of 55 patients. Nervenarzt 1992;63:741-745.

[20] 20. Livingston S. Comprehensive management of epilepsy in infancy, childhood and adolescence. Springfield: Charles Thomas, 1972.

[21] 21. Monetti VC, Granieri E, Casetta I et al. Risk factors for idiopathic generalized seizures: a population-based case control study in Copparo, Italy. Epilepsia 1995;36:224-229.

[22] 22. Murphy CC, Trevathan E, Yeargin-Allsopp M. Prevalence of epilepsy and epileptic seizures in 10-year-old children: results from the Metropolitan Atlanta developmental disabilities study. Epilepsia 1995;36:866-872.

[23] 23. Offringa M, Bossuyt PMM, Lubsen J et al. Risk factor for seizure recurrence in children with febrile seizures: a pooled analysis of individual patient data from five studies. J Pediatrics 1994;124:574-584.

[24] 24. Plõchl E, Laubichler W. Retrospektive Studie bei 160 Kindern mit Fieberkrämpfea Klin Pãdiatr 1992;204:16-20.

[25] 25. Shinnar S, Berg AT, Moshé S et al. Risk of recurrence following a first unprovoked seizure in childhood: a prospective study. Pediatrics 1990;85:1076-1085.

[26] 26. Shinnar S, Kang H, Berg AT, Goldensohn ES, Hauser WA, Moshé SL. EEG abnormalities in children with a first unprovoked seizure. Epilepsia 1994;35:471-476.

[27] 27. Silva CA da. Estudo prospectivo sobre o prognóstico de crises epilépticas recentes não provocadas ocorridas em crianças atendidas em um hospital universitário. Dissertação de Mestrado, Universidade Federal do Paraná. Curitiba, 1995.

[28] 28. Tsuboi T, Endo S, lida N. Long-term follow-up of a febrile convulsion cohort Acta Neurol Scand 1991;84:369-373.

[29] 29. Verity CM, Golding J. Risk of epilepsy after febrile convulsions: a national cohort study. Br Med J 1991;303:1373-1376.

[30] 30. Watts AE. The natural history of untreated epilepsy in a rural community in Africa. Epilepsia 1992;33:464-468.