Reliability of the diagnosis of a first seizure

Donselaar, Cees A. van; Geerts, Ada T.; Meulstee, J.; Habbema, J. Dik F.; Staal, A.

doi:10.1212/wnl.39.2.267

Cited by 74 publications

(21 citation statements)

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“…In Van Donselaar et al's study of 84 children referred with first non-febrile seizure, 63.5% had abnormal EEGs, which is close to the finding of this study (59.37%) (van Donselaar, 1993).…”

Section: Discussionsupporting

confidence: 87%

Evaluation of EEGs of children referred with first non-febrile seizure in Ahvaz, south west of Iran

Momen¹,

Davoodzadeh²,

Morvaridnejad³

2017

nin

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A b s t r a c tIntroduction: Seizures are one of the most common disorders in children. EEG is the most important tool in diagnosis and follow-up in patients with seizures. To diagnose which children might experience recurring seizures, EEG can be helpful. This research was conducted to investigate risk factors of seizure recurrence in non-febrile seizures. Methods: In this descriptive study, EEGs were obtained from all children referred to Ahvaz Golestan hospital following an initial, unprovoked, and untreated seizure. Data were analysed by SPSS version 20, and P < 0.05 was considered as significant. Results: Thirty-two children aged 4 months to 14 years participated. The patients mean age was 2.75 years. Eighteen cases (56.25%) were male and 14 (43.75%) were female. Twenty-seven of the cases had normal birth weight and five had low birth weight. Of the 32 children evaluated, five children (15.62%) had developmental retardation status. The average duration of seizures was 155 seconds. A positive family history of seizures was reported in 13 (40.62%) children. EEG findings were abnormal in 19 patients (59.37%), and they were normal in 13 patients (40.63%), in which three forms were seen: focal spikes in 10 patients (31.25%), focal spikes with slow waves in six patients (18.75%), and general spikes with slow waves in three patients (9.37%). Conclusion: This study revealed a significant correlation between the presence of a family history of seizures and developmental delays in children with first non-febrile seizures and abnormal EEG. It is suggested that EEG be conducted on the first non-febrile seizure, especially in children with a positive family history of seizures or developmental delay.

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“…In Van Donselaar et al's study of 84 children referred with first non-febrile seizure, 63.5% had abnormal EEGs, which is close to the finding of this study (59.37%) (van Donselaar, 1993).…”

Section: Discussionsupporting

confidence: 87%

Evaluation of EEGs of children referred with first non-febrile seizure in Ahvaz, south west of Iran

Momen¹,

Davoodzadeh²,

Morvaridnejad³

2017

nin

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“…Common clinical experience shows that patients with epilepsy are not easy to diagnose with certainty (21,22). However, previous studies have largely ignored this issues,and the NGPSE is the first to include patients with possible/probable diagnosis of epilepsy.…”

Section: Effect Of Diagnosismentioning

confidence: 99%

Prognosis of Epilepsy: A Review and Further Analysis of the First Nine Years of the British National General Practice Study of Epilepsy, a Prospective Population‐Based Study

et al. 1997

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Summary: Purpose:To understand the prognosis of newly diagnosed epilepsy to provide rational therapy and advice for patients and their physicians.Methods: The National General Practice Study of Epilepsy (NGPSE) is the first large population-based study that has assessed the prognosis of patients with newly diagnosed epilepsy prospectively over a prolonged period. We review the previously published data on the prognosis of epilepsy after 9 years of follow-up. One thousand ninety-one patients with newly diagnosed or suspected epilepsy who were attending 1 of 275 general practices throughout the United Kingdom between 1984 and 1987 were ascertained. Cases in this study were defined as the occurrence of one or more seizures, including provoked seizures. Prognosis in terms of remission of seizures, and mortality, was analyzed in the patients who were classified 6 months after recruitment as having definite epilepsy (n = 564) or possible/probable epilepsy (n = 228). Results:Only 33 patients were completely lost to follow-up. After 9 years, 86% [95% confidence interval (CI) 81, 901 of patients with definite epilepsy had achieved a remission of 3 years, and 68% (CI 61, 7 3 , had achieved a remission of 5 years. For the complete cohort, with possible/probable epilepsy included, the rates increased to 87% (CI 83, 91) for 3-year remission and 71% (CI 65, 77) for 5-year remission. The proportion of patients with definite epilepsy who were still in remission at 9-year follow-up (terminal remission) was 68% (CI 62,74) for 3-year remission and 54% (CI 48,60) for 5-year remission. When stratified by etiology, the proportions achieving 5-year remission by 9 years was 69% (CI 60, 77) for idiopathic seizures, and 61% (CI 46, 75) for remote symptomatic epilepsy. Age and seizure type had small effects on the chances of achieving remission, with children experiencing slightly lower rates than older patients, and partial seizures having lower remission rates than generalized seizures. The overall standardized mortality ratio (SMR) for patients with definite or possible/probable epilepsy was 2.5 (CI 2.1, 2.9), and 3.0 (CI 2.5, 3.7) for patients who were classified as having definite epilepsy. The SMR for patients with idiopathic epilepsy was 1.6 (CI 1.0,2.4), for those with remote symptomatic epilepsy it was 4.3 (CI 3.3, 5 . 3 , and for those with acute symptomatic epilepsy it was 2.9 (CI 1.7, 4.5).Conclusions: Overall, most patients with epilepsy wiil enter remission; however, there is a higher than expected risk of death, especially in those with symptomatic epilepsy. Key Words: Epilepsy-Prognosis-The National General Practice Study of Epilepsy.There are two important aspects of prognosis in epilepsy; the chances of achieving remission of seizures and the chances of premature death. Accurate data on these aspects provide standards against which medical advances can be judged and are important for rational therapy and advice. The study of the prognosis of epilepsy has been confounded because of methodological problems and because...

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“…No single clinical symptom can reliably discriminate between a seizure and a nonepileptic event. 7,8 Studies have investigated whether serum prolactin levels 9,10 or creatine kinase levels 11 may help distinguish seizures from nonepileptic events, but neither of these tests is sufficiently reliable to use routinely.…”

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confidence: 99%

Practice parameter: Evaluating a first nonfebrile seizure in children

Hirtz¹,

Ashwal²,

Berg³

et al. 2000

Neurology

345

230

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Article abstract-Objective: The Quality Standards Subcommittee of the American Academy of Neurology develops practice parameters as strategies for patient management based on analysis of evidence. For this practice parameter, the authors reviewed available evidence on evaluation of the first nonfebrile seizure in children in order to make practice recommendations based on this available evidence. Methods: Multiple searches revealed relevant literature and each article was reviewed, abstracted, and classified. Recommendations were based on a three-tiered scheme of classification of the evidence. Results: Routine EEG as part of the diagnostic evaluation was recommended; other studies such as laboratory evaluations and neuroimaging studies were recommended as based on specific clinical circumstances. Conclusions: Further studies are needed using large, well-characterized samples and standardized data collection instruments. Collection of data regarding appropriate timing of evaluations would be important.

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Reliability of the diagnosis of a first seizure

Cited by 74 publications

References 1 publication

Evaluation of EEGs of children referred with first non-febrile seizure in Ahvaz, south west of Iran

Evaluation of EEGs of children referred with first non-febrile seizure in Ahvaz, south west of Iran

Prognosis of Epilepsy: A Review and Further Analysis of the First Nine Years of the British National General Practice Study of Epilepsy, a Prospective Population‐Based Study

Practice parameter: Evaluating a first nonfebrile seizure in children

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