Early Recurrence of First Unprovoked Seizures in Children

Leah R. Goldberg, Catherine G. Kernie, Kathleen Lillis, Jonathan Bennett, Gregory Conners, Charles G. Macias, James Callahan, Cigdem Akman, W. Allen Hauser, Nathan Kuppermann, Peter S. Dayan

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objectives: The risk of early seizure recurrences after first unprovoked seizures in children is largely unknown. We aimed to determine the rate of seizure recurrence within 14 days of first unprovoked seizures in children and identify associated risk factors. Secondarily, we aimed to determine the risk of recurrence at 48 hours and 4 months. Methods: We conducted a secondary analysis of a multicenter cohort study of children 29 days to 18 years with first unprovoked seizures. Emergency department (ED) clinicians completed standardized histories and physical examinations. The primary outcome, recurrent seizure at 14 days, and the secondary outcomes, recurrence at 48 hours and 4 months, were assessed by telephone follow-up and medical record review. For each recurrence time point, we excluded those patients for whom no seizure had recurred but chronic antiepileptic drugs had been initiated. Results: A total of 475 patients were enrolled in the parent study. Of evaluable patients for this secondary analysis, 26 of 392 (6.6%, 95% confidence interval [CI] = 4.4%–9.6%) had recurrences within 48 hours of the incident seizures, 58 of 366 (15.8%, 95% CI = 12.3%–20.0%) had recurrences within 14 days, and 107 of 340 (31.5%, 95% CI = 26.6%–36.7%) had recurrences within 4 months. On logistic regression analysis, age younger than 3 years was independently associated with a higher risk of 14-day recurrence (adjusted odds ratio [OR] = 2.1, 95% CI = 1.2–3.7; p = 0.01). Having had more than one seizure within the 24 hours prior to ED presentation was independently associated with a higher risk of seizure recurrence at 48 hours (adjusted OR = 4.3, 95% CI = 1.9–9.8; p < 0.001). Conclusions: Risk of seizure recurrence 14 days after first unprovoked seizures in children is substantial, with younger children at higher risk. Prompt completion of an electroencephalogram and evaluation by a neurologist is appropriate for these children.

Original languageEnglish (US)
Pages (from-to)275-282
Number of pages8
JournalAcademic Emergency Medicine
Volume25
Issue number3
DOIs
StatePublished - Mar 1 2018

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Seizures
Recurrence
Confidence Intervals
Hospital Emergency Service
Odds Ratio
Telephone
Anticonvulsants
Multicenter Studies
Physical Examination
Medical Records
Electroencephalography
Cohort Studies
Logistic Models
Regression Analysis

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Goldberg, L. R., Kernie, C. G., Lillis, K., Bennett, J., Conners, G., Macias, C. G., ... Dayan, P. S. (2018). Early Recurrence of First Unprovoked Seizures in Children. Academic Emergency Medicine, 25(3), 275-282. https://doi.org/10.1111/acem.13341

Early Recurrence of First Unprovoked Seizures in Children. / Goldberg, Leah R.; Kernie, Catherine G.; Lillis, Kathleen; Bennett, Jonathan; Conners, Gregory; Macias, Charles G.; Callahan, James; Akman, Cigdem; Allen Hauser, W.; Kuppermann, Nathan; Dayan, Peter S.

In: Academic Emergency Medicine, Vol. 25, No. 3, 01.03.2018, p. 275-282.

Research output: Contribution to journalArticle

Goldberg, LR, Kernie, CG, Lillis, K, Bennett, J, Conners, G, Macias, CG, Callahan, J, Akman, C, Allen Hauser, W, Kuppermann, N & Dayan, PS 2018, 'Early Recurrence of First Unprovoked Seizures in Children', Academic Emergency Medicine, vol. 25, no. 3, pp. 275-282. https://doi.org/10.1111/acem.13341
Goldberg LR, Kernie CG, Lillis K, Bennett J, Conners G, Macias CG et al. Early Recurrence of First Unprovoked Seizures in Children. Academic Emergency Medicine. 2018 Mar 1;25(3):275-282. https://doi.org/10.1111/acem.13341
Goldberg, Leah R. ; Kernie, Catherine G. ; Lillis, Kathleen ; Bennett, Jonathan ; Conners, Gregory ; Macias, Charles G. ; Callahan, James ; Akman, Cigdem ; Allen Hauser, W. ; Kuppermann, Nathan ; Dayan, Peter S. / Early Recurrence of First Unprovoked Seizures in Children. In: Academic Emergency Medicine. 2018 ; Vol. 25, No. 3. pp. 275-282.
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abstract = "Objectives: The risk of early seizure recurrences after first unprovoked seizures in children is largely unknown. We aimed to determine the rate of seizure recurrence within 14 days of first unprovoked seizures in children and identify associated risk factors. Secondarily, we aimed to determine the risk of recurrence at 48 hours and 4 months. Methods: We conducted a secondary analysis of a multicenter cohort study of children 29 days to 18 years with first unprovoked seizures. Emergency department (ED) clinicians completed standardized histories and physical examinations. The primary outcome, recurrent seizure at 14 days, and the secondary outcomes, recurrence at 48 hours and 4 months, were assessed by telephone follow-up and medical record review. For each recurrence time point, we excluded those patients for whom no seizure had recurred but chronic antiepileptic drugs had been initiated. Results: A total of 475 patients were enrolled in the parent study. Of evaluable patients for this secondary analysis, 26 of 392 (6.6{\%}, 95{\%} confidence interval [CI] = 4.4{\%}–9.6{\%}) had recurrences within 48 hours of the incident seizures, 58 of 366 (15.8{\%}, 95{\%} CI = 12.3{\%}–20.0{\%}) had recurrences within 14 days, and 107 of 340 (31.5{\%}, 95{\%} CI = 26.6{\%}–36.7{\%}) had recurrences within 4 months. On logistic regression analysis, age younger than 3 years was independently associated with a higher risk of 14-day recurrence (adjusted odds ratio [OR] = 2.1, 95{\%} CI = 1.2–3.7; p = 0.01). Having had more than one seizure within the 24 hours prior to ED presentation was independently associated with a higher risk of seizure recurrence at 48 hours (adjusted OR = 4.3, 95{\%} CI = 1.9–9.8; p < 0.001). Conclusions: Risk of seizure recurrence 14 days after first unprovoked seizures in children is substantial, with younger children at higher risk. Prompt completion of an electroencephalogram and evaluation by a neurologist is appropriate for these children.",
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AU - Goldberg, Leah R.

AU - Kernie, Catherine G.

AU - Lillis, Kathleen

AU - Bennett, Jonathan

AU - Conners, Gregory

AU - Macias, Charles G.

AU - Callahan, James

AU - Akman, Cigdem

AU - Allen Hauser, W.

AU - Kuppermann, Nathan

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N2 - Objectives: The risk of early seizure recurrences after first unprovoked seizures in children is largely unknown. We aimed to determine the rate of seizure recurrence within 14 days of first unprovoked seizures in children and identify associated risk factors. Secondarily, we aimed to determine the risk of recurrence at 48 hours and 4 months. Methods: We conducted a secondary analysis of a multicenter cohort study of children 29 days to 18 years with first unprovoked seizures. Emergency department (ED) clinicians completed standardized histories and physical examinations. The primary outcome, recurrent seizure at 14 days, and the secondary outcomes, recurrence at 48 hours and 4 months, were assessed by telephone follow-up and medical record review. For each recurrence time point, we excluded those patients for whom no seizure had recurred but chronic antiepileptic drugs had been initiated. Results: A total of 475 patients were enrolled in the parent study. Of evaluable patients for this secondary analysis, 26 of 392 (6.6%, 95% confidence interval [CI] = 4.4%–9.6%) had recurrences within 48 hours of the incident seizures, 58 of 366 (15.8%, 95% CI = 12.3%–20.0%) had recurrences within 14 days, and 107 of 340 (31.5%, 95% CI = 26.6%–36.7%) had recurrences within 4 months. On logistic regression analysis, age younger than 3 years was independently associated with a higher risk of 14-day recurrence (adjusted odds ratio [OR] = 2.1, 95% CI = 1.2–3.7; p = 0.01). Having had more than one seizure within the 24 hours prior to ED presentation was independently associated with a higher risk of seizure recurrence at 48 hours (adjusted OR = 4.3, 95% CI = 1.9–9.8; p < 0.001). Conclusions: Risk of seizure recurrence 14 days after first unprovoked seizures in children is substantial, with younger children at higher risk. Prompt completion of an electroencephalogram and evaluation by a neurologist is appropriate for these children.

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