Shinnar S, Berg A T, Moshé S L, Petix M, Maytal J, Kang H, Goldensohn E S, Hauser W A
Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467.
Pediatrics. 1990 Jun;85(6):1076-85.
In a prospective study, 283 children who presented with a first unprovoked seizure were followed for a mean of 30 months from the time of first seizure. Subsequent seizures were experienced by 101 children (36%). The cumulative risk of seizure recurrence for the entire study group was 26% at 12 months, 36% at 24 months, 40% at 36 months, and 42% at 48 months. The cumulative risk of recurrence in the 47 children with a remote symptomatic first seizure was 37%, 53%, and 60% at 12, 24, and 36 months, respectively, compared with a cumulative risk of 24%, 33%, and 36% at 12, 24, and 36 months, respectively, in the 236 children who had had an idiopathic first seizure (P less than .01). In children with an idiopathic first seizure, the electroencephalogram was the most important predictor of recurrence. The cumulative risk of recurrence in the 81 children with abnormal electroencephalograms was 41%, 54%, and 56% at 12, 24 and 36 months, respectively, but only 15%, 23%, and 26% at 12, 24, and 36 months, respectively, in the 138 children with normal electroencephalograms (P less than .001). A history of epilepsy in a first-degree relative was a significant risk factor only in idiopathic cases with abnormal electroencephalograms. In children with a remote symptomatic first seizure, either a history of prior febrile seizures or the occurrence of a partial seizure were significant predictors of recurrence. Age at first seizure and duration of seizure did not affect recurrence risk in either the idiopathic or remote symptomatic group. A total of 84% of the children were not treated with antiepileptic drugs or were treated for less than 2 weeks. Only 9% were treated for longer than 3 months. Treatment did not affect the risk of recurrence. The results suggest that, even without treatment, the majority of children with a first unprovoked seizure will not experiment a recurrence. Children with an idiopathic first seizure and a normal electroencephalogram have a particularly favorable prognosis.
在一项前瞻性研究中，283名首次出现无诱因癫痫发作的儿童从首次发作时起平均随访30个月。101名儿童（36%）出现了后续癫痫发作。整个研究组癫痫复发的累积风险在12个月时为26%，24个月时为36%，36个月时为40%，48个月时为42%。47名首次发作有远期症状性癫痫的儿童在12、24和36个月时复发的累积风险分别为37%、53%和60%，而236名首次发作属于特发性癫痫的儿童在12、24和36个月时复发的累积风险分别为24%、33%和36%（P<0.01）。在首次发作属于特发性癫痫的儿童中，脑电图是复发的最重要预测因素。脑电图异常的81名儿童在12、24和36个月时复发的累积风险分别为41%、54%和56%，而脑电图正常的138名儿童在12、24和36个月时复发的累积风险分别仅为15%、23%和26%（P<0.001）。一级亲属中有癫痫病史仅在脑电图异常的特发性病例中是一个显著的风险因素。在首次发作有远期症状性癫痫的儿童中，既往热性惊厥病史或部分性癫痫发作的发生是复发的显著预测因素。首次发作时的年龄和癫痫发作持续时间在特发性或远期症状性组中均不影响复发风险。共有84% 的儿童未接受抗癫痫药物治疗或治疗时间少于2周。只有9% 的儿童治疗时间超过3个月。治疗不影响复发风险。结果表明，即使不进行治疗，大多数首次出现无诱因癫痫发作的儿童也不会复发。首次发作属于特发性癫痫且脑电图正常的儿童预后特别良好。
