Is a first acute symptomatic seizure epilepsy? Mortality and risk for recurrent seizure

Hesdorffer, Dale C.; Benn, Emma K. T.; Cascino, Gregory D.; Hauser, W. Allen

doi:10.1111/j.1528-1167.2008.01945.x

Cited by 357 publications

(315 citation statements)

References 7 publications

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“…The prevalence of febrile seizures in this hospital‐based study was low, suggesting that many children with seizures are not admitted to the hospital. The seizures classified as acute symptomatic seizures may have been epileptic seizures 7. It is impossible to rule out residual confounding from factors not documented in this study.…”

Section: Discussionmentioning

confidence: 89%

“…Other studies found increased risk for epilepsy but after seizures related to cerebrovascular disease7 and encephalitis 8. Additionally, early acute symptomatic seizures following trauma or ischemia increased the risk of subsequent epilepsy,9, 10 suggesting these acute seizures may be a marker of persistent susceptibility to repetitive unprovoked seizures, that is, epilepsy.…”

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confidence: 99%

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Risk of convulsive epilepsy following acute seizures in Kenyan children

2016

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SummaryObjectiveThe prevalence of epilepsy is high in Africa, and people with epilepsy often have a history of acute seizures. We determined whether acute seizures are associated with risk for epilepsy in rural Africa, where both conditions are common and may have shared risk factors.MethodsA total of 16,438 children (2,991 with acute seizures and 13,447 without seizures) admitted to Kilifi County Hospital from 2002 to 2008 were followed up with epidemiological surveys conducted in 2003 and 2008 to assess the prevalence of epilepsy and the associated risk factors. Cox proportional hazards regression models were used to identify the risk factors. Prevalence ratios were computed using log binomial regression models.ResultsThe prevalence of epilepsy was higher in admissions with acute seizures (5.0% [95% confidence interval (CI), 4.3–5.9%]) than in those without seizures (0.7% [95% CI, 0.5–0.8%]), p < 0.0001). Acute seizures were associated with epilepsy after accounting for potential confounders in a Cox regression model (hazard ratio [HR] = 1.53 [95% CI, 1.10–2.14]). Prevalence was greater in complex acute seizures (5.9%; prevalence ratio [PR] = 1.58 [95% CI, 1.13–2.20]) or status epilepticus (7.5%; PR = 1.96 [95% CI, 1.32–2.91]) than in simple acute seizures (3.7%). Factors independently associated with epilepsy following acute seizures in Cox regression models were perinatal complications (HR = 3.60 [95% CI, 1.89–6.87]), cerebral palsy (HR = 1491.51 [95% CI, 144.30–15,416.21]), duration of follow‐up (HR = 1.21 [95% CI, 1.09–1.35]), and malnutrition (relative risk [RR] = 0.24 [95% CI, 0.08–0.69]).SignificanceAcute seizures in children are associated with subsequent risk for epilepsy that is greater than in the general population. The burden of epilepsy may be reduced by control of causes of acute seizures.

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Section: Discussionmentioning

confidence: 89%

mentioning

confidence: 99%

Risk of convulsive epilepsy following acute seizures in Kenyan children

2016

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“…симп томатические судороги, или судорожный синдром, являются одним из наиболее частых и грозных проявлений нейроинфекций, осложня-ющих течение заболевания и повышающих веро-ятность развития симптоматической эпилепсии [3][4][5][6]. К ним относятся пароксизмы, возникаю-щие в прямой временной связи с заболеванием.…”

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“…К ним относятся пароксизмы, возникаю-щие в прямой временной связи с заболеванием. Острые симптоматические судороги могут быть как однократными, так и повторными, в течение 7 суток и более [4,5]. В их основе лежит пораже-ние нейронов вследствие прямого цитопатоген-ного действия инфекционного агента либо опос-редованно через сосудистые или аутоиммунные механизмы [6].…”

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ACUTE NEUROINFECTIONS AND SYMPTOMATIC EPILEPSY IN CHILDREN: CAUSAL RELATIONSHIP (review)

Горелик¹,

Войтенков²,

Скрипченко³

et al. 2017

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ВведениеНейроинфекции являются одной из актуаль-нейших проблем детской инфектологии и не-врологии в связи с растущим уровнем заболева-емости, составляющим до 3-5% всех инфекци-онных заболеваний у детей, высокой степенью тяжести течения, летальностью, достигающей при некоторых нозологических формах 50-70%, и частотой формирования выраженного резидуального неврологического дефицита, ска-зывающегося на качестве жизни переболевших и определяющего высокую медико-социаль-ную значимость данной проблемы [1,2]

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“…21 While children are rarely affected by ischemic, embolic, or hemorrhagic stroke, up to two-thirds of patients who experience perinatal infarction will eventually develop epilepsy, and in 25% of these cases, the seizures will be medically intractable. 13,16,25 Epilepsy surgery in children is safe and effective and can provide substantive gains in quality of life and developmental milestones, 15,36 but in general, it remains an underutilized treatment modality for multiple reasons, including but not limited to historical prejudice, practitioner bias, and parental concern over loss of functional capability.…”

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confidence: 99%

Surgical management of medically refractory epilepsy due to early childhood stroke

Ghatan

McGoldrick

Palmese

et al. 2014

PED

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Object The risk of developing epilepsy after perinatal stroke, hypoxic/ischemic injury, and intracerebral hemorrhage is significant, and seizures may become medically refractory in approximately 25% of these patients. Surgical management can be difficult due to multilobar or bilateral cortical injury, nonfocal or poorly lateralizing video electroencephalography (EEG) findings, and limited functional reserve. In this study the authors describe the surgical approaches, seizure outcomes, and complications in patients with epilepsy due to vascular etiologies in the perinatal period and early infancy. Methods The records were analyzed of 19 consecutive children and adults with medically refractory epilepsy and evidence of perinatal arterial branch occlusions, hypoxic/ischemic insult, or hemorrhagic strokes, who underwent surgery at the Comprehensive Epilepsy Center of Beth Israel Medical Center and St. Luke's-Roosevelt Hospital Center. Preoperative findings including MRI, video EEG, functional MRI, and neuropsychological testing were analyzed. The majority of patients underwent staged operations with invasive mapping, and all patients had either extra- or intraoperative functional mapping. Results In 7 patients with large porencephalic cysts due to major arterial branch occlusions, periinsular functional hemispherotomy was performed in 4 children, and in 3 patients, multilobar resections/disconnections were performed, with 1 patient undergoing additional resections 3 years after initial surgery due to recurrence of seizures. All of these patients have been seizure free (Engel Class IA) after a mean 4.5-year follow-up (range 15–77 months). Another 8 patients had intervascular border-zone ischemic infarcts and encephalomalacia, and in this cohort 2 hemispherotomies, 5 multilobar resections/disconnections, and 1 focal cortical resection were performed. Seven of these patients remain seizure free (Engel Class IA) after a mean 4.5-year follow-up (range 9–94 months), and 1 patient suffered a single seizure after 2.5 years of seizure freedom (Engel Class IB, 33-month follow-up). In the final 4 patients with vascular malformation-associated hemorrhagic or ischemic infarction in the perinatal period, a hemispherotomy was performed in 1 case, multilobar resections in 2 cases, and in 1 patient a partial temporal lobectomy was performed, followed 6 months later by a complete temporal and occipital lobectomy due to ongoing seizures. All of these patients have had seizure freedom (Engel Class IA) with a mean follow-up of 4.5 years (range 10–80 months). Complications included transient monoparesis or hemiparesis in 3 patients, transient mutism in 1 patient, infection in 1 patient, and a single case of permanent distal lower-extremity weakness. Transient mood disorders (depression and anxiety) were observed in 2 patients and required medical/therapeutic intervention. Conclusions Epilepsy surgery is effective in controlling medically intractable seizures after perinatal vascular insults. Seizure foci tend to be widespread and rarely limited to the area of injury identified through neuroimaging, with invasive monitoring directing multilobar resections in many cases. Long-term functional outcomes have been good in these patients, with significant improvements in independence, quality of life, cognitive development, and motor skills, despite transient postoperative monoparesis or hemiparesis and occasional mood disorders.

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Is a first acute symptomatic seizure epilepsy? Mortality and risk for recurrent seizure

Cited by 357 publications

References 7 publications

Risk of convulsive epilepsy following acute seizures in Kenyan children

Risk of convulsive epilepsy following acute seizures in Kenyan children

ACUTE NEUROINFECTIONS AND SYMPTOMATIC EPILEPSY IN CHILDREN: CAUSAL RELATIONSHIP (review)

Surgical management of medically refractory epilepsy due to early childhood stroke

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