Operational diagnosis of epilepsy in children at undetermined risk: A meta-analysis of prognostic factors for seizure recurrence

Giuditta Pellino; Raffaella Faggioli; Laura Madrassi; Raffaele Falsaperla; Agnese Suppiej

doi:10.1016/j.yebeh.2021.108498

Operational diagnosis of epilepsy in children at undetermined risk: A meta-analysis of prognostic factors for seizure recurrence

Epilepsy Behav. 2022 Feb:127:108498. doi: 10.1016/j.yebeh.2021.108498. Epub 2021 Dec 23.

Authors

Giuditta Pellino¹, Raffaella Faggioli², Laura Madrassi², Raffaele Falsaperla³, Agnese Suppiej²

Affiliations

¹ Pediatric Unit, Azienda USL Ferrara - University Hospital of Ferrara, Ferrara, Italy; Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy. Electronic address: pllgtt@unife.it.
² Department of Medical Sciences, Section of Pediatrics, University of Ferrara, Ferrara, Italy.
³ Neonatal Intensive Care Unit, AOU San Marco-Policlinico, University of Catania, Via Carlo Azeglio Ciampi, 95121 Catania, Italy.

PMID: 34954509
DOI: 10.1016/j.yebeh.2021.108498

Abstract

Purpose: According to the operational epilepsy definition adopted by the International League Against Epilepsy (ILAE) in 2014, in patients with one unprovoked seizure, clinicians must stratify the recurrence risk to determine if the criteria for diagnosis of epilepsy have been met and if antiseizure medications (ASM) are required. A remote symptomatic etiology was considered to be one of the best predictors for seizure recurrence, also according to the available prediction tools, but in children with a previously negative history and a normal neurological examination, estimating the probability of seizure relapse remains less obvious. This meta-analysis aimed to fill this gap of knowledge.

Methods: The PubMed, Embase, and Scopus databases were searched from January 2000 to December 2020. We selected studies reporting children (1 month-18 years old) presenting a first unprovoked seizure. The absence of a known remote neurological pathology had to be clearly stated in the paper or the idiopathic/cryptogenic group data were used; the finding of epileptogenic structural brain MRI abnormalities during the diagnostic workup at the moment of the first unprovoked seizure was not an exclusion criterion. Factors analyzed, as possible predictors of recurrence, included: age at onset, sex, family history of epilepsy, type of seizure (focal or generalized), epileptiform abnormalities on EEG, and epileptogenic structural brain MRI abnormalities.

Results: Four studies met the inclusion criteria and the sample size consisted of 741 children. The estimated recurrence rate within 3 years was 50% (95%CI:33.9%-66.0%). Among the predictors of recurrence, focal seizure (OR = 1.52; 95%CI = 1.05-2.19), epileptiform abnormalities on EEG (OR = 1.97; 95%CI = 1.31-2.96), and positive family history for epilepsy (OR = 2.37; 95%CI = 1.56-3.59) were associated with a statistically significant increased risk.

Conclusion: The analysis of data available until now cannot adequately assess the risk of recurrence after a first unprovoked seizure in neurotypical children. Prospective and multicenter cohort studies are expected.

Keywords: Childhood epilepsy; First seizure; Recurrence; Single seizure.

Publication types

Meta-Analysis
Review

MeSH terms

Child
Electroencephalography / adverse effects
Epilepsy* / diagnosis
Epilepsy* / etiology
Humans
Multicenter Studies as Topic
Prognosis
Prospective Studies
Recurrence
Risk Factors
Seizures* / drug therapy