Risk of seizure recurrence in children with new-onset afebrile seizure

  • Mufeed Akram Taha Department of Medicine, College of Medicine, University of Kirkuk, Kirkuk, Iraq https://orcid.org/0000-0001-5726-0733
  • Noorjan Abdullah Muhammed Department of Pediatric, College of Medicine, University of Kirkuk, Kirkuk, Iraq
Keywords: electroencephalography, neuroimaging, recurrence, seizure
Abstract viewed: 295 times
PDF downloaded: 200 times
HTML downloaded: 93 times
EPUB downloaded: 64 times


BACKGROUND A seizure is a brief change in the normal neuronal electrical activity of the brain that causes changes in consciousness, perception, behavior, or movement. This study aimed to evaluate clinical findings, initial electroencephalography (EEG), and brain imaging findings as predictors of seizure recurrence after the first nonfebrile seizure.

METHODS This prospective follow-up study was conducted at Azadi Teaching Hospital, Kirkuk from July 2019 to January 2022 and enrolled 150 patients, ranging from 1 month to 15 years of age, who presented with their first afebrile seizure. The seizure types were classified based on the International League Against Epilepsy in 2017. A brain imaging with EEG was performed within 72 hours after admission.

RESULTS The median age of the patients was 5 years. A higher risk of seizure recurrence occurred in patients with focal seizure (relative risk [RR] = 6.604) (95% confidence interval [CI] 3.975–10.971), seizure occurrence at sleep (RR = 3.815) (95% CI 2.410–6.039), an abnormal neurological presentation such as Todd’s paralysis (RR = 1.739) (95% CI 1.252–2.415), a positive family history of seizures (RR = 2.333) (95% CI 1.598–3.408), abnormal EEG (RR = 0.171) (95% CI 0.092–0.318), and abnormal brain image findings (RR = 0.681) (95% CI 0.492–0.941) within 72 hours. Seizure recurrence was not correlated with sex.

CONCLUSIONS Early and late childhood new-onset afebrile seizures with a positive family history, focal epilepsy, seizure during sleep, prolonged attack duration with frequent attacks within 24 hours, and abnormal initial EEG and brain image had a high risk of seizure recurrence.


Download data is not yet available.


  1. Hana NN, Taha MA, Abass KS. Vascular biomarkers study among epileptic patients with monotherapy. Biochem Cell Arch. 2020;20(1):859-68.

  2. Ali N, Haider S, Mustahsan S, Shaikh M, Raheem A, Soomar SM, et al. Predictors of abnormal electroencephalogram and neuroimaging in children presenting to the emergency department with new-onset afebrile seizures. BMC Pediatr. 2022;22(1):619. https://doi.org/10.1186/s12887-022-03668-6

  3. Ayanoğlu M, Ongun EA. The predictive factors for prolonged seizures and status epilepticus: a single center study. Med J Bakirkoy. 2021;17(1):53-63. https://doi.org/10.5222/BMJ.2021.16362

  4. Harahap HS, Rizki M, Irawati D. Factors associated with global cognitive impairment in epilepsy patients: a cross-sectional study in Mataram, Indonesia. Med J Indones. 2022;31(3):155-9. https://doi.org/10.13181/mji.oa.226118

  5. M P, Dudipala SC, Shankar R, Reddy RV, Ch AK. A prospective hospital-based study on the clinico-etiological profile of the first episode of a seizure in children. Cureus. 2022;14(11):e31242.

  6. Maia C, Moreira AR, Lopes T, Martins C. Risk of recurrence after a first unprovoked seizure in children. J Pediatr (Rio J). 2017;93(3):281-6. https://doi.org/10.1016/j.jped.2016.07.001

  7. Woo S, Nah S, Kim M, Kim S, Lee D, Moon J, et al. Risk of epilepsy in children presenting to emergency departments with their first afebrile seizure: a retrospective multicenter study. Children (Basel). 2022;9(11):1741. https://doi.org/10.3390/children9111741

  8. Khair AM, Ibrahim K, Alshami R, Veten A, Elmagrabi D, Mohamed K. EEG profile & yield in evaluation of first non-febrile seizures in children-first observational study in Qatar. J Neurol Neurophysiol. 2015;6(6). https://doi.org/10.5339/qfarc.2016.HBPP1770

  9. Kumar R. Etiology, clinical profile and outcome of first episode of seizure in children. Eur J Mol Clin Med. 2023;10(01):6142-7.

  10. Neligan A, Adan G, Nevitt SJ, Pullen A, Sander JW, Bonnett L, et al. Prognosis of adults and children following a first unprovoked seizure. Cochrane Database Syst Rev. 2023;1(1):CD013847. https://doi.org/10.1002/14651858.CD013847.pub2

  11. Pellino G, Faggioli R, Madrassi L, Falsaperla R, Suppiej A. Operational diagnosis of epilepsy in children at undetermined risk: a meta-analysis of prognostic factors for seizure recurrence. Epilepsy Behav. 2022;127:108498. https://doi.org/10.1016/j.yebeh.2021.108498

  12. Jomaa N, Nasreddine W, Hmeimess G, Beaini S, Beydoun A, Hotait M, et al. Risk of recurrence in patients with an unprovoked tonic-clonic seizure and generalized epileptiform discharges on EEG. Epilepsia. 2023;64(8):2153-61. https://doi.org/10.1111/epi.17671

  13. Momen AA, Davoodzadeh H, Morvaridnejad M. Evaluation of EEGs of children referred with first non-febrile seizure in Ahvaz, south west of Iran. Neuropsychiatr Neuropsychol. 2017;12(2):49-53. https://doi.org/10.5114/nan.2017.70632

  14. Lawn ND, Pang EW, Lee J, Dunne JW. First seizure from sleep: clinical features and prognosis. Epilepsia. 2023. Epub ahead of print. https://doi.org/10.1111/epi.17712

  15. Rizvi S, Ladino LD, Hernandez-Ronquillo L, Téllez-Zenteno JF. Epidemiology of early stages of epilepsy: risk of seizure recurrence after a first seizure. Seizure. 2017;49:46-53. https://doi.org/10.1016/j.seizure.2017.02.006

  16. Poudyal P, Shrestha RP, Shrestha PS, Dangol S, Shrestha NC, Joshi A, et al. Clinical profile and electroencephalogram findings in children with seizure presenting to Dhulikhel Hospital. Kathmandu Univ Med J (KUMJ). 2016;14(56):347-51.

  17. Woo S, Nah S, Kim M, Kim S, Lee D, Lee J, et al. Factors associated with neuroimaging abnormalities in children with afebrile seizure: a retrospective multicenter study. West J Emerg Med. 2023;24(2):279-86. https://doi.org/10.5811/westjem.2022.12.57505

  18. Wirrell EC. Prognostic significance of interictal epileptiform discharges in newly diagnosed seizure disorders. J Clin Neurophysiol. 2010;27(4):239-48. https://doi.org/10.1097/WNP.0b013e3181ea4288

  19. Wirrell E. Evaluation of first seizure and newly diagnosed epilepsy. Continuum (Minneap Minn). 2022;28(2):230-60. https://doi.org/10.1212/CON.0000000000001074

  20. Özdemir FMA, Öztoprak Ü, Atasoy E, Aksoy E, Çelik H, Ceylan N, et al. Characteristics and clinical value of early electroencephalography (EEG) after a first unprovoked seizure in children. Neurophysiol Clin. 2023;53(1):102848. https://doi.org/10.1016/j.neucli.2023.102848

  21. Ulusoy E, Uysal Ateş Ş, Çitlenbik H, Öztürk A, Şık N, Arslan G, et al. What is the safe observation period for seizure recurrence in pediatric emergency departments? Epilepsy Behav. 2023;139:109049. https://doi.org/10.1016/j.yebeh.2022.109049

  22. Seneviratne U, Cook M, D'Souza W. Brainwaves beyond diagnosis: wider applications of electroencephalography in idiopathic generalized epilepsy. Epilepsia. 2022;63(1):22-41. https://doi.org/10.1111/epi.17119

  23. Amagasa S, Uematsu S, Tsuji S, Nagai A, Abe Y, Kubota M. Identification of children with first afebrile seizure for whom neuroimaging is unnecessary. Seizure. 2021;93:140-4. https://doi.org/10.1016/j.seizure.2021.10.022

  24. Üner Ç, Tekeli A, Karacan CD. Evaluation of the results of patients with a first afebrile seizure admitted to a pediatric emergency department. J Pediatr Emerg Intensive Care Med. 2021;8:146-50. https://doi.org/10.4274/cayd.galenos.2020.71501

  25. Elfeshawy MS, Afia AA, Alsawah AY, Mohammed MI, Abdelkader AA. Role of neuroimaging and electroencephalogram in first unprovoked seizures in children from Cairo. The Scientific Journal of Al-Azhar Medical Faculty, Girls. 2019;3(2):503-16. https://doi.org/10.4103/sjamf.sjamf_15_19

  26. Ponnatapura J, Vemanna S, Ballal S, Singla A. Utility of magnetic resonance imaging brain epilepsy protocol in new-onset seizures: how is it different in developing countries? J Clin Imaging Sci. 2018;8:43. https://doi.org/10.4103/jcis.JCIS_38_18

  27. Dedeoglu O, Ardicli D. Evaluation and management of the first unprovoked seizure in children: single-center experience first unprovoked seizure in children. Ann Med Res. 2022;29(11):1263-7. https://doi.org/10.5455/annalsmedres.2022.05.162

How to Cite
Taha MA, Muhammed NA. Risk of seizure recurrence in children with new-onset afebrile seizure. Med J Indones [Internet]. 2023Oct.9 [cited 2024Jul.25];32(2):80-5. Available from: https://mji.ui.ac.id/journal/index.php/mji/article/view/6927
Clinical Research