Etiology, clinical profile and outcome of first episode of seizure in children


  • R. Prasanna Department of Paediatrics, SRM Medical College Hospital and Research Centre, Kattankulathur, Chennai, Tamil Nadu India
  • Sekar Pasupathy Department of Paediatrics, SRM Medical College Hospital and Research Centre, Kattankulathur, Chennai, Tamil Nadu India
  • Fayrouz Moidu Department of Paediatrics, SRM Medical College Hospital and Research Centre, Kattankulathur, Chennai, Tamil Nadu India



Pediatric first seizures, Recurrent seizures, Unprovoked seizures


Background: Seizure is a commonly encountered problem in pediatric practice. Convulsive disorder constitutes a heterogeneous group with a varied etiology. Arriving at the cause of seizure is important as it plays a vital role in managing the child. Chances of recurrence to be analyzed, after the first episode of seizure for management. The aim was to study the etiology and the causes of recurrence after a first episode seizure.

Methods: A prospective observational study was done on 135 children for a period of two months admitted in tertiary care center. Proper history, complete neurological and other systemic examinations was done. Blood investigations and imaging with EEG was done when indicated. All children were classified according to International League against epilepsy and followed up for recurrence rate and history leading to recurrence. Co- relation between recurrence and risk factors was analyzed.

Results: Electroencephalogram tracing was abnormal in 62 out of 105 children. 19 out of 62 had recurrence while only 2 among 43 normal EEG had recurrence. This was statistically significant (P value 0.001). Children with remote symptomatic etiology constitutes the majority in those with abnormal EEG tracings. In children with remote symptomatic etiology, only one child had normal EEG. Remote symptomatic had higher number of abnormal EEG when compared to others and was found to have more recurrence.

Conclusions: Children with EEG abnormalities after the first episode of afebrile seizure have more chance of recurrence. Children with seizure secondary to remote symptomatic etiology had more recurrences.


Bluvstein JS, Moshe SL. First unprovoked seizure Current Management in child Neurology. 3rd ed. Pmph USA Ltd; 2005:89-92.

Pohlmann-Eden B, Beghi E, Campfield C, Campfield P. The first seizure and its management in adults and Children. Brit Med J. 2006;332:339-42.

Berg AT, Shinnar S. The risk of seizure recurrence following a first unprovoked seizure: a quantitative review. Neurology. 1991;41:965-72.

Nordli DR, Bazil CW, Scheuer ML, Pedley TA. Recognition and classification of seizures in infants. Epilepsia. 1997;38:553-60.

Camfield PR, Camfield CS, Dooley JM, Tibbles JA, Fung T, Garner B. Neurology epilepsy after a first unprovoked seizure in childhood. Neurology. 1985;35(11):1657-60.

Inaloo S, Sadeghi E, Rafiee M, Heydari ST. Risk of Seizure Recurrence Following a First Unprovoked Seizure in Childhood. Iranian Red Crescent Med J. 2008;10(4):303-8.

Shinnar S, Anne T. Berg, Solomon L Moshe, Christine O dell, Marta Alemany et al .The risk of seizure recurrence after a first unprovoked afebrile seizure in childhood: An extended follow-up. Seizure. Pediatrics 1996; 98:216-225.

Hauser WA, Anneger JF. Epidemiology of acute symptomatic seizures. Epilepsy: a comprehensive text book. vol.1. 2nd ed. Philadelphia: Lipincott-Raven; 2008:87-91.

Mathur S, Southern K, Sharma M. Significant findings on cranial CT scan after a first unprovoked seizure in children from North India. J Trop Pedia. 2007;53(6):428-30.

Ellenberg JH, Nelson KB. Age of onset of seizures in young children. Ann Neurol. 1984;15:127-34.

Khreisat WH. Clinical profile of epilepsy during the first two years of life. Pak J Med Sci. 2006;22(1):55-9.

Annegeers JF, Hauser WA, Lee JRJ, Roca W. Incidence of acute symptomatic seizures in Rochester, Minnesota, 1935-1984. Epilepsia. 1995;36:327-33.

Murthy JMK, Yangala R. Acute symptomatic seizures-incidence and etological spectrum: a hospital-based study from South India. Seizure. 1999;(8):162-7.

Ong LC, Dhillon MK, Selladurai. Early post-traumatic seizures in children: clinical and radiological aspects of injury. J Paediatric Child Health. 1996;32(2):173-6.

Frey LC. Epidemiology of posttraumatic epilepsy: a critical review. Epilepsia. 2003;44 suppl 10:11-7.

Sridhar K, Kumar P, katariya S. Post asphyxial encephalopathy in preterm neonates. Indian J Pediatric. 2001;68(12):1121-5.

Jallon P. Epilepsy in developing countries. ILAE workshop report. Epilepsia. 1997;38:1143-51.

Scotoni AE, Maria LG. Manreza and Guerreiro MM. Recurrence after a first unprovoked cryptogenic/idiopathic seizure in children: a prospective study from Sao Paulo, Brazil. Epilepsia. 2004;45(2):166-70.

Camfield PR, Camfield CS, Dooley JM, Tibbles JA, Fung T, Garner B. Epilepsy after a first unprovoked seizure in childhood. Neurol. 1985;35:1657-60.

Stroink H, Brouwer OF, Arts WF, Geerts AT, Peters AB, van Donselaar CA. The first unprovoked, untreated seizure in childhood: a hospital based study of the accuracy of the diagnosis, rate of recurrence, and long term outcome after recurrence. Dutch study of epilepsy in childhood. J Neurol Neurosurg Psychia. 1998;64:595-600.

Shinnar S, O’Dell C, Berg AT. Mortality following a first unprovoked seizure in children: a prospective study. Neurol. 2005;64:880.






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