Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands.
Department of Pediatrics, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands.
Epilepsia Open. 2024 Apr;9(2):548-557. doi: 10.1002/epi4.12883. Epub 2024 Jan 25.
New-onset seizure-like events (SLEs) are common in children, but differentiating between epilepsy and its mimics is challenging. This study provides an overview of the clinical characteristics, diagnoses, and corresponding etiologies of children evaluated at a first seizure clinic (FSC), which will be helpful for all physicians involved in the care of children with SLEs.
We included 1213 children who were referred to the FSC of a Dutch tertiary children's hospital over a 13-year period and described their clinical characteristics, first routine EEG recording results, and the distribution and specification of their eventual epilepsy and non-epilepsy diagnoses. The time interval to correct diagnosis and the diagnostic accuracy of the FSC were evaluated.
"Epilepsy" was eventually diagnosed in 407 children (33.5%), "no epilepsy" in 737 (60.8%), and the diagnosis remained "unclear" in 69 (5.7%). Epileptiform abnormalities were seen in 60.9% of the EEG recordings in the "epilepsy" group, and in 5.7% and 11.6% of the "no epilepsy" and "unclear" group, respectively. Of all children with final "epilepsy" and "no epilepsy" diagnoses, 68.6% already received their diagnosis at FSC consultation, and 2.9% of the children were initially misdiagnosed. The mean time to final diagnosis was 2.0 months, and 91.3% of all children received their final diagnosis within 12 months after the FSC consultation.
We describe the largest pediatric FSC cohort to date, which can serve as a clinical frame of reference. The experience and expertise built at FSCs will improve and accelerate diagnosis in children with SLEs.
Many children experience events that resemble but not necessarily are seizures. Distinguishing between seizures and seizure mimics is important but challenging. Specialized first-seizure clinics can help with this. Here, we report data from 1213 children who were referred to the first seizure clinic of a Dutch children's hospital. One-third of them were diagnosed with epilepsy. In 68.8% of all children-with and without epilepsy-the diagnosis was made during the first consultation. Less than 3% were misdiagnosed. This study may help physicians in what to expect regarding the diagnoses in children who present with events that resemble seizures.
新发作的癫痫样事件（SLEs）在儿童中很常见，但区分癫痫和其类似物具有挑战性。本研究提供了在首次癫痫诊所（FSC）评估的儿童的临床特征、诊断和相应病因的概述，这将有助于所有参与 SLEs 儿童护理的医生。
我们纳入了 1213 名在荷兰一家三级儿童医院的 FSC 就诊的儿童，并描述了他们的临床特征、首次常规脑电图记录结果以及最终癫痫和非癫痫诊断的分布和具体情况。评估了明确诊断的时间间隔和 FSC 的诊断准确性。
最终诊断为“癫痫”的有 407 名儿童（33.5%），诊断为“无癫痫”的有 737 名儿童（60.8%），诊断仍为“不明”的有 69 名儿童（5.7%）。在“癫痫”组的脑电图记录中，60.9%可见癫痫样异常，而在“无癫痫”和“不明”组中分别为 5.7%和 11.6%。所有最终诊断为“癫痫”和“无癫痫”的儿童中，68.6%在 FSC 就诊时已得到诊断，2.9%的儿童最初被误诊。明确诊断的平均时间为 2.0 个月，91.3%的儿童在 FSC 就诊后 12 个月内得到了最终诊断。
我们描述了迄今为止最大的儿科 FSC 队列，可作为临床参考。在 FSC 积累的经验和专业知识将改善和加速 SLEs 儿童的诊断。
