Cumulative Incidence of Seizures and Epilepsy in Ten-Year-Old Children Born Before 28 Weeks' Gestation

Abstract

Objective To evaluate seizures and epilepsy incidence in the first decade of life among children born extremely premature (< 28 weeks gestation). Method In a prospective, multi-center, observational study, 889 of 966 eligible children born 2002–2004 were evaluated at 2 and 10 years for neurological morbidity. Complementing questionnaire data to determine a history of seizures, all caregivers were interviewed retrospectively for post-neonatal seizures using a validated seizure screen followed by a structured clinical interview by a pediatric epileptologist. A second pediatric epileptologist established an independent diagnosis based on recorded responses of the interview. A third epileptologist determined the final diagnosis when evaluators disagreed (3%). Lifetable survival methods were used to estimate seizure incidence through 10 years. Results By age 10 years, 12.2% percent (95% CI: 9.8, 14.5) of children had ≥1 seizure, 7.6% (95% CI 5.7, 9.5) had epilepsy, 3.2% had seizure with fever, and 1.3% had a single, unprovoked seizure. Seizure incidence increased with decreasing gestational age. In more than 75% of children with seizures, onset was after one year of age. Seizure incidence was comparable in both sexes. Two-thirds of those with epilepsy had other neurological disorders. One-third of children with epilepsy were not recorded on the medical history questionnaire. Significance The incidence of epilepsy through 10 years of age among children born extremely premature is approximately 7 to 14-fold higher than the 0.5–1% lifetime incidence reported in the general pediatric population. Seizures in this population are under-recognized, and possibly under-diagnosed, by parents and providers.

Evaluation of Risk Factors for Epilepsy in Pediatric Patients with Cerebral Palsy

“…The authors conclude that the risk of epilepsy in this group was 7-14 times higher than in the general population and the main risk factor was the duration of the pregnancy-the shorter the pregnancy duration, the higher the risk of seizures and epilepsy. In three-quarters of the group, the seizure onset was in the first year of life and two-thirds of children had comorbidities like intellectual developmental delay, autistic spectrum disorders, attention deficit disorder, and, on neuroimaging, abnormalities of white matter [40]. Of our patients, 14 (i.e., 7.86%) were born before 28 weeks of gestation; in nine of them, epilepsy was diagnosed and two met the criteria for drug-resistant epilepsy.…”

“…In an American study, 889 out of 966 children born before 28 weeks of gestation were evaluated at age two and again at age 10 [40]. By age 10, at least one seizure had been observed in 12.2% of the group, and epilepsy was diagnosed in 7.6%.…”

Assessing Positive Child Health among Individuals Born Extremely Preterm

“…While the child was tested, the parent or caregiver completed questionnaires. Eleven disorders were investigated: moderate/severe cognitive impairment [6], bilateral blindness [10], hearing impairment [10], gross motor function impairment [6]; epilepsy [5]; attention-deficit/ hyperactivity disorder (ADHD) [11]; autism [4]; anxiety, depression; asthma; and obesity (i.e., body mass index (BMI) above the 95 percentile). These were used to generate a PCHI.…”

Cognitive Development and Quality of Life Associated With BPD in 10-Year-Olds Born Preterm

“…Seizure identification was achieved via a screening questionnaire followed by an open-ended interview conducted by an epileptologist. 42…”