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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 EEG.On multivariable 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. |
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seizure
seizure,activation procedures
seizure,children
seizure,prognosis in childhood
sleep
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