Predictive Factors for Seizure Recurrence in Pediatric Patients Following an Unprovoked Seizure

Abstract Background We studied the predictive factors related to seizure recurrence in children who presented with an unprovoked seizure at our pediatric neurology clinic over 4 years period. Aim To explore the predictive factors underlying seizure recurrence following an unprovoked seizure and the diagnostic yield of performing an initial EEG in pediatric patients. Methods We retrospectively reviewed the charts of patients who had an unprovoked seizure and were followed up for at least one year from February 2016 until February 2020. Relevant demographic and clinical data, electroencephalogram (EEG), and brain magnetic resonance imaging (MRI) findings were recorded and analyzed at annual intervals. Patients with acute neurological insult and those who were diagnosed with an epilepsy syndrome or who were already receiving antiseizure medications were excluded from the study. Results The predictive factors for seizure recurrence were focal seizures, symptomatic seizures due to a remote static lesion such as “perinatal insult, infection, stroke, or cerebral malformation”, abnormal initial EEG results and abnormal brain MRI findings. The recurrence rate was 96.2% in our cohort, of which 68.8% occurred within six months of the first seizure. On using the Kaplan-Meyer survival analysis curve, the probable risk of having a second unprovoked seizure among all patients was 91.8, 94.7 and 98.4% at 1, 2 and 3 years respectively but it was significantly higher among children with symptomatic seizure etiology at each interval. Conclusion Our cohort of patients showed an increased risk of seizure recurrence with several risk factors implicated, among those was having an abnormal initial EEG. This indicates the importance of having a baseline EEG study in predicting the risk of seizure recurrence, especially in children with symptomatic seizure etiology. The highest risk of recurrence was observed in the first six months warranting close monitoring of children during this period.