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Departments of Neurology (Dr. Shinnar, Y. Ptachewich, and M. Alemany), and Pediatrics (Dr. Shinnar), and the Montefiore/Einstein Epilepsy Management Center (Dr. Shinnar, and Y. Ptachewich, and M. Alemany), Montefiore Medical Center, The Albert Einstein College of Medicine, Bronx, NY; and the Department of Pediatrics (Dr. Berg), Yale University School of Medicine, New Haven, CT.
In a prospective study, we have followed 347 children identified at the time of a first unprovoked seizure for a mean of 46 months. To date, 135 (39%) have experienced a seizure recurrence. In this study, we analyzed recurrence risk as a function of whether the child was asleep or awake at the time of the first seizure. The cumulative recurrence risks for children whose first seizure occurred in sleep was 28% at 0.5 years, 39% at 1 year, 53% at 2 years, and 55% at 4 years, compared with recurrence risks of 18%, 23%, 30%, and 35% at the same intervals in children whose first seizure occurred while awake (p < 0.001). The association of a first seizure during sleep with an increased recurrence risk was present primarily in children with idiopathic seizures. It occurred in both those with a normal and an abnormal EEC On multivariate analysis, sleep state, etiology, and the EEG were statistically significant predictors of recurrence risk. In children who experienced a seizure recurrence, the recurrences occurred in the same sleep state in 73% of the cases (p < 0.0001). This was also true of subsequent recurrences. We conclude that the occurrence of a first seizure in sleep is associated with an increased risk of recurrence. Subsequent seizures, -if they do occur, usually occur in the same sleep state as the initial seizure.
Presented in part at the American Epilepsy Society Meetings, Philadelphia, PA, December 1991.
Address correspondence and reprint requests to Dr. Shlomo Shinnar, Epilepsy Management Center, Montefiore Medical Center, 111 E. 210th Street, Bronx, NY 10467.
Supported in part by grant 1 R01 NS26151 (S. Shinnar) and a FIRST award 1 R29 NS27728 (A. Berg) from the National Institute of Neurological Disorders and Stroke.
Received May 27, 1992. Accepted for publication in final form August 14, 1992.
This article has been cited by other articles:
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  K. S. Mastriani, V. C. Williams, T. C. Hulsey, J. W. Wheless, and B. L. Maria Evidence-Based Versus Reported Epilepsy Management Practices J Child Neurol, May 1, 2008; 23(5): 507 - 514. [Abstract] [PDF]
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 D. Hirtz, S. Ashwal, A. Berg, D. Bettis, C. Camfield, P. Camfield, P. Crumrine, R. Elterman, S. Schneider, and S. Shinnar Practice parameter: Evaluating a first nonfebrile seizure in children: Report of the Quality Standards Subcommittee of the American Academy of Neurology, the Child Neurology Society, and the American Epilepsy Society Neurology, September 12, 2000; 55(5): 616 - 623. [Abstract] [Full Text] [PDF]
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 H. Stroink, O. F Brouwer, W. F. Arts, A. T Geerts, A C B. Peters, and C. A van Donselaar The first unprovoked, untreated seizure in childhood: a hospital based study of the accuracy of the diagnosis, rate of recurrence, and long term outcome after recurrence. Dutch study of epilepsy in childhood J. Neurol. Neurosurg. Psychiatry, May 1, 1998; 64(5): 595 - 600. [Abstract] [Full Text] [PDF]
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A. T. Berg and S. Shinnar The Contributions of Epidemiology to the Understanding of Childhood Seizures and Epilepsy J Child Neurol, October 1, 1994; 9(2_suppl): 2S19 - 2S26. [Abstract] [PDF]
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