| J Neurol Neurosurg Psychiatry. 1998 May; 64(5): 595–600. | PMCID: PMC2170103 |
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, O. Brouwer, W. F. Arts, A. Geerts, A Peters, and C. A van Donselaar Department of Neurology, University Hospital, Rotterdam-Sophia Children's Hospital, The Netherlands. 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
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