Maia Catarina, Moreira Ana Raquel, Lopes Tânia, Martins Cecília
Centro Hospitalar de Vila Nova de Gaia/Espinho, Serviço de Pediatria, Vila Nova de Gaia, Portugal.
Centro Hospitalar do Médio Ave, Serviço de Pediatria, Famalicão, Portugal.
J Pediatr (Rio J). 2017 May-Jun;93(3):281-286. doi: 10.1016/j.jped.2016.07.001. Epub 2016 Oct 7.
This study aimed to evaluate the first episode of unprovoked epileptic seizure in children and assess recurrence risk factors.
This was a retrospective observational study, based on the analysis of medical records of patients admitted between 2003 and 2014, with first epileptic seizure, at the pediatric service of a secondary hospital. The data were analyzed using the SPSS 20.0 program.
Of the 103 patients, 52.4% were boys. The median age at the first seizure was 59 (1-211) months. About 93% of children were submitted to an electroencephalogram at the first episode and 47% underwent neuroimaging assessment. Treatment with an antiepileptic drug was started in 46% of patients. The recurrence rate was 38% and of these, 80% had the second seizure within six months after the first event. Of the assessed risk factors, there was a statistically significant association between seizure during sleep and recurrence (p=0.004), and between remote symptomatic etiology seizure and occurrence of new seizure (p=0.02). The presence of electroencephalogram abnormalities was also associated with the occurrence of new seizures (p=0.021). No association was found between age, duration of the seizure, and family history of epilepsy with increased risk of recurrence.
Most children with a first unprovoked epileptic seizure had no recurrences. The risk of recurrence was higher in patients with seizure occurring during sleep or remote symptomatic ones and those with abnormal electroencephalogram results.
本研究旨在评估儿童首次无诱因癫痫发作情况，并评估复发风险因素。
这是一项回顾性观察研究，基于对2003年至2014年间在一家二级医院儿科首次癫痫发作入院患者的病历分析。使用SPSS 20.0程序对数据进行分析。
103例患者中，52.4%为男孩。首次发作的中位年龄为59（1 - 211）个月。约93%的儿童在首次发作时接受了脑电图检查，47%接受了神经影像学评估。46%的患者开始使用抗癫痫药物治疗。复发率为38%，其中80%在首次发作后6个月内出现第二次发作。在评估的风险因素中，睡眠中发作与复发之间存在统计学显著关联（p = 0.004），既往有症状性病因发作与新发作的发生之间存在关联（p = 0.02）。脑电图异常也与新发作的发生有关（p = 0.021）。未发现年龄、发作持续时间和癫痫家族史与复发风险增加之间存在关联。
大多数首次无诱因癫痫发作的儿童未复发。睡眠中发作或既往有症状性发作以及脑电图结果异常的患者复发风险较高。
