The second part of the revised definition of epilepsy by ILAE in 2014 allows a condition to be considered epilepsy after one seizure if there is a high risk of having another seizure; if the risk factor is not precisely be known we have to wait for another seizure. This definition necessitates search for probable risk factors. We aimed this study to assess the recurrence rate and associated risk factors for recurrences after a first unprovoked seizure in children within two years of first attack. This prospective study was conducted on in Banglabandhu Sheikh Mujib Medical University (BSMMU) from June 2016 to December 2018. Among 137 children finally 120 children aged between1 month to 14 years after a first seizure were followed up for 2 years. Diagnosis of seizure was confirmed on the basis of diagnostic criteria and none of the children was treated by any antiepileptic drugs after first episode. Overall recurrence rate within 2 years of follow up was 38%. Majority of recurrence (65%) observed within 6-10 months of initial seizure. Significant risk factors were an abnormal EEG finding (p=<0.001), focal seizure (p=<0.001), seizure at sleep (p=0.001) and initial presentation with status epilepticus (p=0.001). Abnormal neuroimage findings were also associated with seizure recurrence, but it was not statistically significant. Age of the patients and underlying motor and cognitive delay was not a significant risk factor for recurrence. A great percentage of first seizure didn’t show recurrence but there are so many factors can determine the possibilities of recurrence, early identification of risk factors specially the focal pattern of seizure, seizure in sleep, status epilepticus and abnormal electrophysiology are the best predictive factors of recurrence, so identifying the high risk group of recurrence helps to initiate early antiepileptic drug and prevent further recurrence.
Stroink H, Brouwer OF, Arts WF, Greerts AT, Peters ACB, Donselaar CAV. 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. J NeurolNeurosurg Psychiatry. 1998;64:595-600.
Pearce JL, Mackintosh HT. Prospective study of convulsions in childhood. N Z Med J. 1979;89:1-3.
Camfield PR, Camfield CS, Dooley JM, Tibbles JAR, Fung T, Garner B. Epilepsy after a first unprovoked seizure in childhood. Neurology. 1985;35:1657-60.
Hirtz DG, Ellenberg JH, Nelson KB. The risk of recurrence of nonfebrile seizures in children. Neurology 1984;34:637-40.
Hauser WA, Rich SS, Annergers JF, Anderson VE. Seizure recurrence after a first unprovoked seizure: An extended follow up. Neurology. 1990; 40: 1163-70.
Winckler MI, Rotta NT. Prognostic factors for recurrence of a first seizure during childhood. ArqNeuropsiquiatr. 1997;55:749-56.
Scotoni AE, Guerriero MM, De Abreu HJ. First epileptic crisis. Analysis of risk of recurrence. ArqNeuropsiquiatr. 1999;57:392-400.
Pairoj B. Risk of recurrence following a first unprovoked seizure in Thai children. Neurol J Southeast Asia. 2003;8:25-29.
Shinner S, Berg AT, Moshe SL, Petix M, Maytal J, Kang H et al. Risk of seizure recurrence following a first unprovoked seizure in childhood: a prospective study. Pediatrics. 1990; 85: 1076-85.
Fisher RS, Acevedo C, Arzimanoglou A, Bogacz A, Cross H, Elger CE et al. A practical clinical definition of epilepsy. Epilepsia, 2014;55(4):475-82.
Marson A, Jacoby A, Johnson A, Gamble C, Chadwick D. Immediate versus differed antiepileptic drug treatment for early epilepsy and single seizures: a randomized controlled trial. Lancet, 2005; 365: 2007-13.
Berg AT, Shinner S, Testa FM, Levy SR, Frobish D, Smith S, Beckerman B. Status epilepticus after the initial diagnosis of epilepsy in children. Neurology, 2004:63:1027-34.
Berg AT, Shinner S. The risk of seizure recurrence following a first unprovoked seizure: a quantatative review. Neurology,1991;41:965-972.
First Seizure Trial Group. Randomized clinical trial of the efficacy of the antiepileptic drugs in reducing the risk of relapse after a first unprovoked tonic-clonic seizure. Neurology,1993; 43: 478-83.
Winckler MI, Rotta NT. Clinical and electrographic follow up after a first unprovoked seizure. Pediatr Neurol.2004;30:201-6.
Maia C, Moreira AR, Lopes T, Martins C.Risk of recurrence after a first unprovoked seizure in children. J Pediatr (Rio J). 2016. http://dx.doi.org/10.1016/j.jped.2016.07.001.
Kim LG, Johnson TL, Marson AG, Chadwick DW. Prediction of risk of seizure recurrence after a single seizure and early epilepsy: further result from the MESS trial. Lancet Neurol, 2006: 1780-85.
Ramos LJ, Cassinello GE, Carrasco Marina LL, Vazquez LM, Martin Gonzalez MM, Munoz HA. Seizure recurrence after a first unprovoked seizure in childhood: a prospective study. Epilepsia,2000;41:1005-13.
Bora I, Seckin B, Zarifoglu M, Turan F, Sadikoglu SEO. Risk of recurrence after first unprovoked tonic clonic seizure in adults. J Neurol,1995;242:157-63.
Berkovic SF, Scheffer IE. Febrile seizures: genetics and relationship to other epilepsy. CurrOpinNeurol, 1998;11:129-34.
Mizorogi S, Kanemura H, Sano F, Sugita K, Aihara M. Risk factors for seizure recurrence in children after first unprovoked seizure. Pediatr Int. 2015;57:665-9.
Loiseau P, Loiseau J, Jalon P, Zelicourt M. Is the risk of recurrence following a first epileptic event greater after single or multiple onset?.Epilepsia, 1999;40:87.
Kho LK, Lawn ND, Dunne JW, Linto J. First seizure presentation: do multiple seizures within 24 hours predict recurrence? Neurology, 2006;67:1047-49.
Daud AS, Ajloni S, EL-Salem K, Horani K, Otoom S, Daradkeh T. Risk of recurrence after a first unprovoked seizure: a prospective study among Jordanian children.Seizure, 2004;13:99-103.
Panayotopoulos CP. The epilepsies: seizures, syndrome and management. Bladon Medical Publishing, Chipping Norton, UK. 2005. Web of Science/ Google Scholer.
Shinner S, Berg AT, Ptachewich Y et al. Sleep state and the risk of seizure recurrence following a first unprovoked seizure in childhood. Neurology 1993;43”701-6.
Krauss G, Ampaw L, Krumholz A. Individual state driving restrictions for people with epilepsy in the US. Neurology 2001;57:1780-85.
Beghi E, Sander JW. Epilepsy and driving. BMJ 2005;331:60-61.
Scheffer IE, Bhatia KP, Lopes-Cendes I, Fish DR, Marsden CD, Andermann F, Andermann E, Desbiens R, Cendes F, Manson JI, Berkovic SF. Autosomal dominant frontal lobe epilepsy misdiagnosed as sleep disorder. Lancet 1994;343:515-7.
Scheffer IE, Bhatia KP, Lopes-Cendes I, Fish DR, Marsden CD, Andermann F, Andermann E, Desbiens R, Cendes F, Manson JI et al. Autosomal dominant noctarnal frontal lobe epilepsy: a distinctive clinical disorder. Brain 1995;118:61-73.
Annegers JF, Shirts SB, Hauser WA et al. Risk of recurrence after an initial unprovoked seizure. Epilepsia1986;27:43-50.
Boulloche J, Leloup P, Mallet E et al. Risk of recurrence after a single, unprovoked, generalized tonic clonic seizure. Dev Med Child Neurol1989;31:626-32.
Mussico M, Beghi E, Solari A, First Seizure Trial Group. Effect of antiepileptic treatment initiated after the first unprovoked seizure on the long term prognosis of epilepsy. Neurology.1994;44:337-8.