Background: There is still a question whether first SEIZURE leads to epilepsy. Several risk factors have been reported in this relation. This study was undertaken to determine the risk of recurrence after a first UNPROVOKED SEIZURE in children.Methods: In a prospective study between December 2003 and December 2005, 156 children who presented with a first UNPROVOKED SEIZURE were enrolled and followed for at least 18 months. Potential predictors of recurrence were compared, using the Cox Proportional Hazard model in a univariable and multivariate analysis. Survival analysis was performed, using the Kaplan-Meire curves.Results: Seventy two children (46.2%) experienced subsequent SEIZUREs. The cumulative risk of SEIZURE recurrence was 28.8%, 41.7% and 46.2% at 6, 12, and 24 months following the first SEIZURE, respectively. The median time for repeated SEIZURE was 4 months while 62.5% of the recurrence occurred within 6 months, 88.9% within 1 year and 100% till the end of the second year. On multiple analysis, risk factors for resumption of SEIZURE consisted of abnormal electroencephalography (EEG), SEIZURE during sleep, abnormal brain imaging and history of perinatal problems. On univariable analysis, abnormal EEG, abnormal imaging (remote etiology of SEIZURE), history of neonatal problems, previous febrile SEIZURE, and family history of afebrile SEIZURE increased the risk of recurrence.Conclusion: The study revealed that the risk of SEIZURE recurrence in our patients was relatively high. Those who had abnormal electroencephalography, past history of prenatal problems, remote etiology for SEIZURE, abnormal brain imaging, and SEIZURE during sleep were at greater risk for recurrence of SEIZURE.

BACKGROUND: Most of the studies have shown that approximately one third of patients with single SEIZURE will experience a second one. Data regarding SEIZURE-free survival time and recurrence rate vary widely. We investigated the likelihood of a second attack and SEIZURE-free survival time with and without early treatment in our epileptic patients.METHODS: Patients of the first UNPROVOKED SEIZUREs were recruited between 2000-2005 years. They were randomized into two groups: one treated with carbamazepine and the other was not treated. After obtaining a written consent, all patients were followed up for a second SEIZURE for a period ranging from 12 to 36 (19.1±5) months.RESULTS: A total number of 150 patients were enrolled in this study, of which 13 patients were lost to follow up. The remaining patients (71 males and 66 females) were followed up during 5 years. They were randomized into two groups: treatment (50 patients) and non-treatment (87 patients); 30.2% of all patients were without relapsing, of which 48.9% were on treatment (case) and 19.5% did not receive any treatment (the control group). The mean SEIZURE-free survival times were 6 months and 3.8 months in the treated and non-treated patients, respectively (P = 0.017).CONCLUSIONS: We found strong correlation between relapse and treatment started after the first attack (P < 0.05); i.e., the patients who received treatment in their first attack may be at lower risk of relapsing.

Background & Aims: This study was aimed to asses the risk of recurrence after a first UNPROVOKED SEIZURE in children.Materials & Methods: In a prospective study we recruited 156 children who were presented with a first UNPROVOKED SEIZURE and followed for at least 8 months after the first SEIZURE.Results: Seventy two (72) children (46.2%) experienced subsequent SEIZUREs. The cumulative risk of SEIZURE recurrence was 15%, 37.5%, 48% at 1, 6 and 12 months, respectively- following the first SEIZURE. The median time for repeated SEIZURE was 4 months with 62.5% of recurrence occurring within 6 months, 88.88% within 1 year and 100% by the end of two years. On multivariable analysis, risk factors for recurrence of SEIZURE consisted of: abnormal EEG; female gender; occurrence of first SEIZURE during sleep; and abnormal CT scan at the time of occurrence of first SEIZURE. On univariable analysis, history of febrile convulsion, history of neonatal problems, family history of UNPROVOKED SEIZURE, and abnormal neurologic exam increased the risk of recurrence.Conclusion: This study revealed that the risk of SEIZURE in our patients was relatively high. Those who had abnormal EEG, female gender, abnormal CT scan, and occurrence of first SEIZURE during sleep are at greater risk for recurrence of SEIZURE.

Background: Treatment of a single SEIZURE is so complicated and has received much discussion and debate. Objective: To determine the risk rate of recurrence of SEIZURE after the first UNPROVOKED generalized tonic clonic SEIZURE, and ascertain the effectiveness of treatment. Methods: In this prospective study in the neurological ward of Mofid children hospital in 1992, 50 children (from 9 months to 17 years of age) were followed up for one year. Children were randomly divided into two groups, phenobarbital was administered for one group and placebo to the other one. Findings: In the year after the first UNPROVOKED attack, second SEIZURE occurred in 20 children (the recurrence rate was 40%), of which 14 (56%) belonged to placebo group and Six (24%) were in phenobarbital group. The majority of attacks happened in the first 6 months of the year. Conclusion: This study revealed that the use of antiepileptic drugs (phenobarbital) considerably reduces the risk of SEIZURE recurrence.

The approach to a child who has experienced a first UNPROVOKED generalized tonic-clonic SEIZURE is challenging and at the same time controversial.How to establish the diagnosis, ways and means of investigation and whether treatment is appropriate, are different aspects of this subject In this writing the above mentioned matters are discussed.

The approach to a child who has experienced a first UNPROVOKED generalized tonic-clonic SEIZURE is challenging and at the same time controversial. How to establish the diagnosis, ways and means of investigation and whether treatment is appropriate, are different aspects of this subject. In this writing the above mentioned matters are discussed.

Introduction: This study was aimed to asses the rate of recurrence after the first UNPROVOKED SEIZURE in children. Methods and Materials: In a prospective study, we recruited 145 children who presented with primary UNPROVOKED SEIZURE and were followed for at least 12 months after the first SEIZURE. Results: Seventy five children (51.7%) experienced subsequent SEIZUREs. The cumulative risk of SEIZURE recurrence following the first SEIZURE was 16.5%, 35%, 47% and 51.7% at 1, 6, 12, 24 months, respectively. The median time for repeated SEIZURE was 5.4 months with 67% of recurrences occurring within the initial 6 months, 92% within 1 year and 100% before the end of two years. On multivariable analysis, risk factors for resumption of SEIZURE comprised of abnormal   electroencephalography (EEG) and age greater than ten years at the time of occurrence of the first SEIZURE. On unvariable analysis, etiology of SEIZURE, history of neonatal problems and lack of AED (Antiepileptic drugs) usage increased risk of recurrence.Conclusion: This study revealed that the risk of SEIZURE recurrence in our patients was relatively high. Those with abnormal electroencephalography and age greater than ten years at the time of occurrence of the first SEIZURE were at greater risk for recurrence of SEIZUREs.

Background: SEIZURE is one of the most common pediatric neurology problems which occurs in 4-10% of children in the first 16 years of their life. Zinc level has an important role on level of Gamma-amino-butyric acid (GABA) as the main inhibitory neurotransmitter of brain and decrease of serum zinc level might be responsible for pathogenesis of SEIZURE. The purpose of this study was to evaluate blood zinc level of children with first UNPROVOKED SEIZURE (FUS).Methods: In a cross-sectional study, blood zinc level of 1-14 year old admitted children with FUS to Shahid Sadoughi Hospital from December 2012 to May 2013 was measured by coupled plasma mass spectrometry within the first 2 hours after the first SEIZURE attack and Zinc plasma level of less than 70 mg/dL was considered as zinc deficiency. Findings: Forty girls and 56 boys with mean age of 8.35±2.47 years were evaluated that 36 children of them had partial SEIZURE. Serum zinc level was lower in girls than in boys (88.12±9.07 g/dl g/dl vs.112.2±15.45 g/dl, p<0.01).23 children (24%) of children with FUS had zinc deficiency and zinc deficiency was more frequent in partial SEIZURE than in generalized SEIZURE (31% vs.19%, p<0.03).Conclusion: Zinc deficiency may trigger first UNPROVOKED SEIZURE occurrence and blood zinc level assessment might be useful in evaluation of children with FUS and zinc sulfate supplementation might be considered as an effective and safe drug in prevention of SEIZURE occurrence.

Backround: The first episode of an afebrile SEIZURE is a common cause of admission of children to emergency departments. Alot of tests are routinely performed for these patients.The cost of such an evaluation is high and benefits are doubtful. We conducted this study in order to evaluate the results of the tests and find out what tests are necessary for children with first UNPROVOKED SEIZURE.Methods: In a 7-year retrospective study files of 150 children aged between 1 month and 14 years admitted with first afebrile SEIZURE to the pediatric ward of Rasool Akram hospital were reviewed. Reports of the brain neuroimaging studies (Ct-scan & MRI) and laboratory tests were extracted.Results: 150 patients with a mean age of 53±48 months qualified for inclusion in the study.143 (95%) of 150 children with first afebrile SEIZURE were imaged. Ninety percent (128/143) had normal neuroimaging. Emergent computed tomography as the initial study was performed in 90% (128/143) and MRI in 10% (15/143). Sixty patients had both MRI and CT-scans. Clinically significant neuroimaging abnormalities were reported in only 9.7% (14/143). There was a significant relation (P<0.001) between focal SEIZUREs and abnormal neuroimaging. Children under 24 months of age were also more prone to have abnormal imaging (p<0.002). Laboratory tests including complete blood count (CBC) and chemistry panel (Na, K, Ca, BUN, Cr) were performed for all. Only two patients had low serum calcium level, later diagnosed as vitamin D resistant rickets.Conclusions: The most important aspect of management of a child after a first afebrile SEIZURE is careful history taking and physical examination. Laboratory tests should be requested in very limited situations. Emergent brain CT-scans are recommended for children with focal SEIZUREs, abnormal findings on physical examination, presence of any predisposing factors and those under 24 months of age.

Objective: The first attack of UNPROVOKED SEIZURE is more frequent than recurrent one and neuroimaging is one of the main parts of the evaluation of these attacks in order to demonstrate the cause and predict the prognosis. The aim of this study was to determine the incidence of abnormal neuroimaging and related factors in children with the first UNPROVOKED SEIZURE.Materials & Methods: A 7-year retrospective chart review was done on all children who were visited at Ali-Asghar Children’s Hospital with the first UNPROVOKED SEIZURE and underwent neuroimaging including brain computed tomography or magnetic resonance imaging. The diagnostic criteria for the first UNPROVOKED SEIZURE in this study were based on the absence of any immediate or acute cause for the first SEIZURE such as fever, head trauma, hypoglycemia, hypocalcemia, electrolyte imbalance and etc. We compared the rate of abnormal neuroimaging in patients according to different clinical and electroencephalographic (EEG) parameters.Results: One hundred and forty two patients (63 females, 79 males) were included in the study. Twenty eight patients (20%) had abnormal neuroimaging. CT scan and MRI were done in 63% and 37% of the patients, respectively. The most common abnormalities were cerebral dysgenesis (n=9) and cortical brain atrophy (n=6). Patients who were abnormal on neurologic examination had a higher rate of abnormal imaging in comparison with neurologically normal children (51% vs.10%). Abnormal imaging was more frequent in children with an epileptiform activity in EEG compared to normal EEG (34% vs.11%).Although not statistically significant, partial type of SEIZURE, SEIZURE recurrence within 24-hr and age 3-12 year were also associated with a higher rate of abnormal neuroimaging.Conclusion: Neuroimaging should be considered in any child with the first episode of UNPROVOKED SEIZURE, especially those with an abnormal neurologic examination or abnormal EEG.