Objective

The aim of this study was to assess the risk of recurrence after a first unprovoked seizure in childhood and to explore the correlation between the first and second seizures in recurrent patients.

Methods

In a prospective study, we included 467 children aged 1 month to 16 years, who were attended to between November 1, 2008 and October 31, 2016 following a first seizure. Children who had been started on treatment with antiepileptic drugs were excluded. Recurrence rates were calculated using Kaplan–Meier survival analyses. Univariate and multivariate analyses for recurrence risk were performed using the Cox proportional hazards model. The kappa coefficient of correlation for categorical data was calculated.

Results

Recurrences occurred in 280 children (60.0%), of which 75 (26.8%) occurred in the first month, 184 (65.7%) within 6 months, and 256 (91.4%) within 2 years. None of the patients had new neurologic sequelae after their first or second seizure. The estimates of seizure recurrence risk were 39.5%, 48.1%, 55.1%, 60.8%, 61.8% and 61.8% at 0.5, 1, 2, 5, 8, and 10 years after the first seizure, respectively. Multivariate analysis showed that abnormal electroencephalogram and neuroimaging findings significantly increased the risk of recurrence. First and second seizures were significantly associated with state of arousal, status epilepticus, and multiple seizures in recurrent patients.

Conclusion

Over half of untreated children had recurrence after a first unprovoked seizure, but prognosis was good overall.

中文翻译：

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儿童首次无端癫痫发作后癫痫复发的风险

客观的

本研究的目的是评估儿童第一次无端癫痫发作后复发的风险，并探讨复发患者第一次和第二次癫痫发作之间的相关性。

方法

在一项前瞻性研究中，我们纳入了 467 名 1 个月至 16 岁的儿童，他们在 2008 年 11 月 1 日至 2016 年 10 月 31 日期间首次癫痫发作后接受了照料。已开始接受抗癫痫药物治疗的儿童被排除在外。使用 Kaplan-Meier 生存分析计算复发率。使用 Cox 比例风险模型对复发风险进行单变量和多变量分析。计算了分类数据的 kappa 相关系数。

结果

280名儿童（60.0%）复发，其中75名（26.8%）发生在第一个月，184名（65.7%）发生在6个月内，256名（91.4%）发生在2年内。没有患者在第一次或第二次癫痫发作后出现新的神经系统后遗症。在第一次癫痫发作后 0.5、1、2、5、8 和 10 年，癫痫发作复发风险的估计值分别为 39.5%、48.1%、55.1%、60.8%、61.8% 和 61.8%。多变量分析表明，异常的脑电图和神经影像学检查结果显着增加了复发的风险。第一次和第二次癫痫发作与复发患者的觉醒状态、癫痫持续状态和多次癫痫发作显着相关。

结论

超过一半未经治疗的儿童在首次无端癫痫发作后复发，但总体预后良好。