Pediatric Seizure Recurrence

Recurrence rate after first unprovoked seizure ¹:

• 6% recurrence within 48 hours ( 1 in 16 )
• 15.8% recurrence within 14 days (1 in 6)
• 31.5% recurrence within 4 months ( 1 in 3 )
• Age less than 3 yo at onset increases 14 days recurrence, OR 2.1
• 29% recurrence within 1 year ³
• 37% recurrence within 2 years ³
• 43% recurrence within 5 years ³
• 46% recurrence within 10 years ³

Recurrence rate after second unprovoked seizure rises to 72% ³

Recommendations ^2,3:

• Defer EEG testing to outpatient follow up
• Start Anti-Epileptic meds on: (preferably with neurology consultation)
  • Children <3 yo
  • Children with multiple seizures in 24 hrs
  • Those with poor outpatient access

References:

1. Goldberg LR, Kernie CG, Lillis K, et al. Early Recurrence of First Unprovoked Seizures in Children. Acad Emerg Med. 2018;25(3):275-282. PubMed
2. Wendt WL, Dang LT, Rogers AJ. What Happens Next? Recurrence Rates for First Unprovoked Seizures in Children. Acad Emerg Med. 2018;25(3):362-364. PubMed
3. Shinnar S, Berg AT, O’dell C, Newstein D, Moshe SL, Hauser WA. Predictors of multiple seizures in a cohort of children prospectively followed from the time of their first unprovoked seizure. Ann Neurol. 2000;48(2):140-7.PubMed