Better knowledge of the outcomes of children following a first unprovoked seizure including the risk factors for recurrence and the early time course of epilepsy in those children who will recur is needed to understand the evolution of epilepsy and the factors that cause some patients to develop intractable seizures and some to go into remission. Early prediction of poor outcome may identify candidates for aggressive early intervention. Of particular interest are the outcomes and recurrence risks of the subgroup of children who present with status epilepticus as their first unprovoked seizure. Conversely, identifying children with a benign self-limited disorder may allow us to avoid treatment with medications whose use carries with it considerable morbidity. In a prospective study, a cohort of 400 children and adolescents who presented with a first unprovoked seizure have been recruited and followed for a mean of 50 months. Based on the results to date, the following hypotheses are proposed. 1: The majority of children with a first unprovoked seizure will not experience further seizures even after a prolonged observation period of 5 to 10 years. Late recurrences will be a rare event. 2: The majority of the children who do experience further seizures will attain remission. 3: The recurrence risk and long-term prognosis for remission in children with status epilepticus as their first unprovoked seizure will be similar to that of children who present with a brief first seizure. 4: Long-term prognosis and entering remission will be more a function of etiology and the specific epileptic syndrome than of the specifics of the early seizure history (e.g., frequency of seizures and occurrence of prolonged seizures in the first year after the initial seizure). The current study proposes to follow this cohort of 400 children and adolescents with a first unprovoked seizure for an additional 5 years to determine recurrence risks and remission rates. Another cohort of 50 children from the Greater Richmond Status Epilepticus Project who presented with status as their first unprovoked seizure will also be added. Survival analysis techniques will be used to provide estimates of recurrence risk of remission and identify potential predictors of outcome. The results will provide critical information about the long- term outcomes of childhood seizures in a cohort prospectively followed since the time of their first seizure.
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