PROGNOSIS OF CHILDREN WITH A FIRST UNPROVOKED SEIZURE

Knowledge of the natural history of children and adolescents following a first unprovoked seizure and the risk factors for recurrence is a necessary prerequisite for making rational decisions regarding who should be treated with antiepileptic drugs. A better understanding of the early time course of epilepsy in those children who go on to recur is also needed to understand the evolution of epilepsy in those children who go on to recur is also needed to understand the evolution of epilepsy and the factors that cause some patients to develop intractable seizures and some to go into remission. Of particular interest are the outcomes and recurrence risks of the subgroup of children and adolescents who present with status epilepticus as their first unprovoked seizure. Also of interest are children with abnormal electroencephalograms or prior neurological handicap who present with a single seizure. In an ongoing prospective study we have recruited a cohort of 180 children and adolescents who presented with a first unprovoked seizure and have followed them for a mean of one year. Based on our preliminary results the following hypotheses are proposed. 1: The majority of children with a first unprovoked seizure will not have recurrent seizures. 2: Predictive factors including the etiology of seizures (idiopathic vs remote symptomatic) and the electroencephalogram allow identification of subgroups with a very low and a high risk of recurrence. 3: The outcomes of children who present with status epilepticus as their first unprovoked seizure is not significantly different than those who present with a brief seizure. 4: The majority of children who have recurrent seizures will be readily controlled with a single antiepileptic drug and go into remission. The current study proposed to recruit a cohort of 300-350 children and adolescents with a first unprovoked seizure and follow them for a mean of 5 years. Results will be analyzed using Kaplan- Meier techniques which take into account the variable length of follow-up inherent in these studies. These numbers are needed to answer the above hypotheses with sufficient power and provide a sufficiently long follow-up period to ensure the validity of the outcomes. Less than 10% of children with a first seizure are treated with long term medications at our institution. Therefore these results will reflect the true course of the disorder.