Clinical assessment of children with first-attack seizures admitted to the ED

Risk factors for seizure recurrence in a pediatric observation unit

BACKGROUND

Most patients present with seizures to pediatric emergency department (PED) are observed for extended periods for the risk of possible acute recurrence.

OBJECTIVE

The aim of this study is to determine the risk factors of acute recurrence within first 24 h.

METHODS

Patients who presented to PED with seizure during past 24 h were enrolled. Demographic features, number and duration of seizures, diagnostic studies, physical examination findings, presence and time of seizure recurrence in PED were noted.

RESULTS

187 patients were eligible for the study. 46% had recurrence of seizures in 24 h, 90,8% of recurrence within the first 6 h. Univariate analysis showed that younger patients, epileptic patients who were on multiple antiepileptic drugs (AEDs), who had multiple seizures during the past 24 h, who had abnormal neurological examination or neuroimaging findings had increased risk of seizure recurrence. Multivariate analysis showed that number of seizures during the past 24 h and previous use of AEDs was significantly associated with increased risk of recurrence.

CONCLUSION

Risk factors for acute recurrence should be evaluated for each patient. Patients without risk factors and no seizures during the first 6 h should not be observed for extended periods in PED.

Children with convulsive epileptic seizures presenting to padua pediatric emergency department: the first retrospective population-based descriptive study in an Italian Health District

Convulsive epileptic seizures in children represent a common cause of admission to pediatric emergency department. Data about incidence, etiology, and outcome are still lacking in literature. We retrospectively reviewed medical records of children presenting to our pediatric emergency department with convulsive seizures during a 12-month period and collected their diagnoses over the following year. In all, 182 children met the inclusion criteria, for a total of 214 visits (1.2% of all attendances, n = 24 864). Seizures lasted less than 5 minutes in 76%, 5 to 30 minutes in 20%, 30 to 60 minutes in 2%, and over 60 minutes in 2% visits ("early," "established," "refractory," convulsive status epilepticus, respectively). Incidence of "early" (seizure lasting 5-30 minutes) and "established" (seizure lasting 30-60 minutes) status epilepticus was 52/100 000/year and 7/100 000/year respectively. Most common causes were febrile seizures (56%) and remote symptomatic seizures (19%). Knowing the epidemiology of convulsive seizures in children is important to guide appropriate management and individualized follow-up.

Rate of and risk factors for early recurrence in patients with febrile seizures

OBJECTIVE

Patients with febrile seizures (FSs) are observed in emergency departments or admitted to hospitals because of the possibility of recurrence. There are no guidelines regarding the observation time for recurring FS. The aim of this study was to identify the rate, time, risk factors, and cumulative probability of early recurrence.

PATIENTS AND METHODS

This study was a retrospective chart review of patients visiting an emergency department with FS from January to December 2011. Early recurrence was defined as FS recurring within 7 days after the first episode. Patients were divided into 2 groups: early recurrence and nonearly recurrence. The 2 groups were compared in terms of demographics, clinical data, and laboratory findings to identify risk factors for early recurrence. The cumulative probability over time was determined.

RESULTS

In total, 228 patients were identified. The recurrence rate was 17.5% (40/228), and the median time to recurrence was 6.0 hours (interquartile range, 1.1-13.0 hours). The overall cumulative probability of early recurrence was 8.8% within 6 hours, 12.7% within 12 hours, and 15.8% within 24 hours. Most recurrences (90.0%) occurred within 24 hours of the first FS. Early recurrence occurred frequently in patients with nongeneralized-type seizures or seizures of 15-minute duration or longer.

CONCLUSIONS

The majority of recurrent FSs occurred in the first 24 hours. The type and duration of seizures were significant risk factors for early recurrence.