Risk factors for idiopathic generalized seizures: a population-based case control study in Copparo, Italy

Investigating the relationship of positive family history pattern and the incidence and prognosis of idiopathic epilepsy in epilepsy patients

Background:

Epilepsy is one of the most common neurological disorder. This study aimed to investigating the relationship of family history pattern and prognosis of idiopathic epilepsy.

Methods:

In this study, 377 patients with epilepsy referring to Imam clinic were investigated. Data were collected by means of a checklist that contained demographic data, age of first seizure attack, response rate to treatment, parental relationship, seizure history, family history and recurrence of seizure. And then the data were analyzed by SPSS Version 23.

Results:

Among the 337 patients, 199 (52.8 %) individuals were males and 178 (47.2%) individuals were females. The mean age of patients was 28.3±14 years. Approximately 50% of patients had a history of seizure and epilepsy in one of the close first relatives or relatives who had adequate knowledge of their disease. The mean incidence age of epilepsy was lower in patients with a positive family history of disease than those who did not have a family history of epilepsy (p<0.05). Among the 33 patients who did not respond well to treatment, there was a 75% family history of epilepsy (p<0.05). The average age of epilepsy was lower in those with family marriage, but was not statistically significant.

Conclusion:

According to the findings of the present study, the patients diagnosed with idiopathic epilepsy, the family history of epilepsy and seizure, especially in their first degree relatives is fairly high, that may indicate genetic causes in the etiology of the disease.

Risk factors associated with epilepsy development in children with cerebral palsy

OBJECTIVES

Epilepsy is one of the most common and important comorbidity among patients with cerebral palsy (CP). The purpose of this study was to determine the risk factors predicting the development of epilepsy considering prenatal, perinatal, and natal characteristics; associated impairments; and cranial imaging findings in our patient population with cerebral palsy at a tertiary center in Istanbul, Turkey.

METHODS

This retrospective study consisted of 234 children aged between 3 and 18 years of age. Children were divided into two groups as CP patients with epilepsy (126 patients) and CP patients without epilepsy (108 patients). Demographic features and clinical and cranial magnetic resonance imaging (cMRI) findings were compared between the two groups.

RESULTS

Presence of family history of epilepsy, history of neonatal seizure especially in the first 72 h of life, quadriplegic type of CP, severe degree of gross motor function and fine motor disorders, and moderate to severe mental retardation or psycho-social developmental delay were determined as risk factors for the development of epilepsy in CP patients. Also, an increased risk of epilepsy was detected in term infants and appropriate for gestational age (2500-4000 g) infants. On the other hand, presence of parental consanguinity, being born from a primiparous mother, age of mother at birth, mode of delivery, presence of multiple gestation and labor problems, history of follow-up in neonatal intensive care unit and intubation, and cMRI findings were not significant risk factors for the development of epilepsy in CP.

CONCLUSION

Predicting epilepsy development by determining the risk factors in patients with CP might be useful because knowing the risk factors could provide close follow-up of these patients for epilepsy.

Risk of recurrence after a first unprovoked seizure in children

OBJECTIVES

This study aimed to evaluate the first episode of unprovoked epileptic seizure in children and assess recurrence risk factors.

METHODS

This was a retrospective observational study, based on the analysis of medical records of patients admitted between 2003 and 2014, with first epileptic seizure, at the pediatric service of a secondary hospital. The data were analyzed using the SPSS 20.0 program.

RESULTS

Of the 103 patients, 52.4% were boys. The median age at the first seizure was 59 (1-211) months. About 93% of children were submitted to an electroencephalogram at the first episode and 47% underwent neuroimaging assessment. Treatment with an antiepileptic drug was started in 46% of patients. The recurrence rate was 38% and of these, 80% had the second seizure within six months after the first event. Of the assessed risk factors, there was a statistically significant association between seizure during sleep and recurrence (p=0.004), and between remote symptomatic etiology seizure and occurrence of new seizure (p=0.02). The presence of electroencephalogram abnormalities was also associated with the occurrence of new seizures (p=0.021). No association was found between age, duration of the seizure, and family history of epilepsy with increased risk of recurrence.

CONCLUSIONS

Most children with a first unprovoked epileptic seizure had no recurrences. The risk of recurrence was higher in patients with seizure occurring during sleep or remote symptomatic ones and those with abnormal electroencephalogram results.

Glucose transporter 1 deficiency in the idiopathic generalized epilepsies

OBJECTIVE

We examined whether glucose transporter 1 (GLUT1) deficiency causes common idiopathic generalized epilepsies (IGEs).

METHODS

The IGEs are common, heritable epilepsies that usually follow complex inheritance; currently little is known about their genetic architecture. Previously considered rare, GLUT1 deficiency, due to mutations in SLC2A1, leads to failure of glucose transport across the blood-brain barrier and inadequate glucose for brain metabolism. GLUT1 deficiency was first associated with an encephalopathy and more recently found in rare dominant families with epilepsy and paroxysmal exertional dyskinesia (PED). Five hundred four probands with IGEs and 470 controls underwent SLC2A1 sequencing. Glucose transport was assayed following expression of SLC2A1 variants in Xenopus oocytes. All available relatives were phenotyped, and SLC2A1 was sequenced.

RESULTS

Functionally validated mutations in SLC2A1 were present in 7 of 504 (1.4%) probands and 0 of 470 controls. PED, undiagnosed prior to study, occurred in 1 proband and 3 of 13 relatives with mutations. The IGEs in probands and relatives were indistinguishable from typical IGE. Three cases (0.6%) had mutations of large functional effect and showed autosomal dominant inheritance or were de novo. Four (0.8%) cases had a subtle functional effect; 2 showed possible dominant inheritance, and 2 did not. These alleles leading to subtle functional impairment may contribute to complex, polygenic inheritance of IGE.

INTERPRETATION

SLC2A1 mutations contribute to approximately 1% of IGE both as a dominant gene and as a susceptibility allele in complex inheritance. Diagnosis of GLUT1 deficiency has important treatment (ketogenic diet) and genetic counseling implications. The mechanism of restricted glucose delivery differs from the current focus on IGEs as ion channel disorders.

Preterm birth and risk of epilepsy in Swedish adults

OBJECTIVE

To determine whether preterm birth is associated with epilepsy in a national cohort of adults aged 25-37 years.

METHODS

We conducted a national cohort study of 630,090 infants born in Sweden from 1973 through 1979, including 27,953 born preterm (<37 weeks), followed from 2005 to 2009 for 1) hospitalization for epilepsy and 2) outpatient and inpatient prescription of antiepileptic drugs. Epilepsy diagnoses and medication data were obtained from all hospitals and pharmacies throughout Sweden.

RESULTS

We found a strong association between preterm birth and epilepsy that increased by earlier gestational age. After adjusting for fetal growth and potential confounders, odds ratios for hospitalization for epilepsy were 4.98 (95%confidence interval [CI] 2.87-8.62) for those born at 23-31 weeks, 1.98 (95% CI 1.26-3.13) for those born at 32-34 weeks, and 1.76 (95% CI 1.30-2.38) for those born at 35-36 weeks, relative to those born full-term (37-42 weeks). A similar but slightly weaker trend was observed for the association between preterm birth and antiepileptic drug prescription. These associations persisted after excluding individuals with cerebral palsy, inflammatory diseases of the CNS, cerebrovascular disease, and brain tumors.

CONCLUSIONS

These findings suggest that preterm birth, including late preterm birth, is strongly associated with epilepsy in Swedish adults aged 25-37 years. This association was independent of fetal growth and was not mediated by cerebral palsy or other comorbidities.

Risk factors for epilepsy: a population-based case-control study in Kerala, southern India

We undertook a community-based case-control study on persons with active epilepsy residing in Kerala, southern India. Using a standardized questionnaire, we collected information from 362 cases and 362 controls. In the final multivariate model, family history of epilepsy (odds ratio=7.8, 95% confidence interval=3.2-18.8, P=0.000), antecedent history of febrile seizures (7.7, 4.3-14.0, 0.000), birth by complicated delivery (6.8, 2.1-21.8, 0.001), and neonatal seizures (7.8, 1.7-35.4, 008) emerged as strong independent predictors of epilepsy, followed in decreasing order by mental retardation, prematurity, maternal age 30, perinatal distress, and incomplete immunization. There were more similarities than differences in the distribution of risk factors between generalized and localization-related epilepsy syndromes. Our findings suggest interplay between genetic and acquired factors in the pathogenesis of epilepsies, and underscore the need for improvement in obstetric and neonatal care to minimize the epilepsy burden in low-income countries.

Gestational age, birth weight, intrauterine growth, and the risk of epilepsy

The authors evaluated the association between gestational age, birth weight, intrauterine growth, and epilepsy in a population-based cohort of 1.4 million singletons born in Denmark (1979-2002). A total of 14,334 inpatients (1979-2002) and outpatients (1995-2002) with epilepsy were registered in the Danish National Hospital Register. Children who were potentially growth restricted were identified through two methods: 1) sex-, birth-order-, and gestational-age-specific z score of birth weight; and 2) deviation from the expected birth weight estimated based on the birth weight of an older sibling. The incidence rates of epilepsy increased consistently with decreasing gestational age and birth weight. The incidence rate ratios of epilepsy in the first year of life were more than fivefold among children born at 22-32 weeks compared with 39-41 weeks and among children whose birth weight was <2,000 g compared with 3,000-3,999 g. The association was modified by age but remained into early adulthood. Incidence rate ratios of epilepsy were increased among children identified as growth restricted according to either of the two methods. In conclusion, short gestational age, low birth weight, and intrauterine growth restriction are associated with an increased risk of epilepsy.

Prevalence of some risk factors in children with epilepsy compared to their controls

AIM

The goal of this case-control study was to identify the significance of certain risk factors for epilepsy in Turkey.

METHOD

A total of 805 cases, aged 1-16 years, followed-up for epilepsy at the Pediatric Neurology Department and a control group consisting of 846 age-matched cases without epilepsy were included in the study. The risk factors examined were gender, neurological impairment, febrile convulsion, head trauma, central nervous system infections, parental consanguinity, family history of epilepsy, prenatal and natal risk and newborn jaundice. Data regarding the investigated epilepsy risk factors were obtained through a questionnaire via personal interviews and the medical records and were assessed using univariate and multivariate analysis.

RESULT

Univariate analysis showed an increased risk for epilepsy with a history of atypical febrile seizure (21.97-fold), severe and moderate head injury (27.76- and 7.09-fold respectively), CNS infection (4.76-fold), history of epilepsy in first-, second- or third-degree relatives (6.42-, 3.09- and 2.66-fold, respectively), presence of maternal hypertension (4.31-fold), an apgar score < or =6 at any time (7.78-fold) and neonatal jaundice (3.12-fold). Abnormal neurological signs increased the epilepsy risk 5.92 times in univariate analysis and 30.26 times in multivariate analysis.

CONCLUSION

The most important risk factors for epilepsy in this study were neurological impairment, history of atypical febrile seizures, severe head injury and a low apgar score. Other important risk factors were moderate head trauma and a history of epilepsy in the family.

Risk factors for childhood epilepsy: a case-control study

BACKGROUND

Risk factors for epilepsy are conditions associated with an increased frequency of epilepsy, and those for childhood epilepsy are different from those for epilepsy occurring later in life. In the present matched case-control study, we attempted to identify some possible risk factors for childhood epilepsy.

METHODS

All children with epilepsy who attended the clinic of Motahary in Shiraz, Iran during a 6-month period were included in the study. Neurologically normal children, matched for age and sex, visiting the same clinic were considered as controls. The data on patients and controls were obtained from answers to a questionnaire obtained through personal interviews. Details on the patient, family history, parental smoking, breast versus formula feeding, and parental age at the time of childbirth were included. Medical records were then reviewed.

RESULTS

In total, 142 patients and 138 controls participated. Positive family history of epilepsy increased the risk of developing epilepsy by 3.34-fold. A higher risk of epilepsy was observed in patients living in rural areas (OR = 2.44).

CONCLUSIONS

Positive family history of epilepsy and residence in rural areas were the two major risk factors associated with epilepsy in this study; neonatal jaundice, parental age, and passive smoke exposure added no risk. Breast-feeding was not shown to have a protective effect against development of epilepsy.

Genetic liability to epilepsy in Kerala State, India

BACKGROUND

Familial clustering is common in epilepsies, but pedigree patterns suggest a multi-factorial inheritance. Genetic liability for multi-factorial inheritance is population specific and such data are not available for the population of Kerala or other states in south India.

OBJECTIVES

In this study, we have attempted to determine the genetic liability to epilepsy based on an adult population of this state.

MATERIAL AND METHODS

Pedigrees were recorded for probands who reported to the Kerala Registry of Epilepsy and Pregnancy. In order to obtain a genetically matched sample for comparison and estimation of empiric risks, we have used the family history of the spouse except when the spouse was proband's relative. The ILAE criteria were followed for diagnosis and classification of epilepsy.

RESULTS

Data were collected on 18,419 family members of 505 probands with epilepsy (82 men and 423 women) and 10,231 family members of spouses (control). The frequency of epilepsy in first and second-degree relatives of the spouses was comparable to the population frequency (0.5%), justifying the use of this sample as control. Positive family history was observed in 22.2% of probands and 8.24% of controls (Odd's Ratio 3.2, 95% Confidence Interval 2.12-4.73). An affected first-degree relative was observed in 7.5% of probands. The corresponding figure for GE, LRE and other epileptic syndromes were 10.2%, 5.8% and 5.12%, respectively. The segregation ratio for Juvenile Myoclonic Epilepsy (JME) (1:19) was higher than that for other types of Generalized Epilepsy (GE) (1:24) and Localization Related Epilepsy (LRE) (1:52). Prevalence of epilepsy among the first-degree relatives (1.96%) was greater than the square root of the population frequency (0.51%) and was higher than that for second-degree (1.24%) and third-degree (0.64%) relatives for the probands. Probands had higher parental consanguinity (13.07%) compared to controls (6.64%). The above factors support a complex inheritance. Genetic liability to epilepsy (heritability) is greater for GE (0.6) and significantly higher for JME (0.7) compared to LRE (0.4). A limitation of this study is that the inferences are based on a predominantly adult female proband sample but no gender specific differences were identified.

CONCLUSIONS

The observations of this study indicate complex inheritance and the liability values are useful for genetic counseling in the local population. Further studies involving more individuals from younger age group and male gender are envisaged.

Clinical and electroencephalographic follow-up after a first unprovoked seizure

We studied the role of clinical and electroencephalographic factors in the follow-up of children and adolescents after a first unprovoked seizure, and their correlation with recurrence and risk for epilepsy. We conducted a 24-month follow-up of 109 patients aged 1 month to 16 years who had a first unprovoked seizure. We analyzed the characteristics of the first seizure, perinatal history, family history of seizures, electroencephalographic patterns and their influence on seizure recurrence, and calculated risk for subsequent epilepsy. Fifty-six patients (51.4%) had recurrent seizures. The bivariate statistical analysis revealed that maternal prenatal disease (relative risk = 2.02, P = 0.03) and an abnormal electroencephalogram (relative risk = 2.89, P = 0.0003) were significantly associated with seizure recurrence. Other factors (male sex, partial first seizure, vaginal delivery, family history of seizures, and sleep state) approached statistical significance. Logistic regression revealed that the only variable significantly associated with recurrence was an abnormal electroencephalographic pattern on the first examination (relative risk = 2.48, P = 0.003). Cumulative risk ranged from 50-68% at 24 months when the first electroencephalogram was abnormal, and from 26-36% when it was normal. We concluded that the electroencephalogram may have an important diagnostic value in the prognosis of epileptic seizure recurrence in children and adolescents.

Risk factors for childhood epilepsy: a case-control study from Irbid, Jordan

OBJECTIVE

The goal of this case-control study is to identify the significance of certain risk factors for epilepsy in a population of epileptic children in Northern Jordan. The risk factors examined are febrile convulsions, head trauma, central nervous system infections, abnormal perinatal history, family history and parental consanguinity.

METHODOLOGY

We designed a case-control study for patients attending the outpatient neurology clinic of Princess Rahma Teaching Hospital in Irbid, Jordan during a 7-month period. Controls were selected, matched for age and sex, from a group of non-epileptic patients attending the general paediatrics outpatient clinic in the same hospital and during the same period. Data about the investigated risk factors were obtained by personal interview and review of the medical records and were analysed statistically for significance.

RESULTS

The total number of participants was 200 patients and controls each. History of febrile convulsions, head trauma, abnormal perinatal history and family history showed a statistically significant increase risk for developing epilepsy. Central nervous system infections and parental consanguinity did not add to the risk of developing epilepsy.

CONCLUSION

Positive family history for epilepsy, head trauma, febrile convulsions and abnormal perinatal history were shown to have a statistically significant association with epilepsy in patients attending Princess Rahma Teaching Hospital in Northern Jordan. Although consanguinity is widely practised in Jordan, it appears that it does not increase the risk of epilepsy probably due to the small contribution of monogenic recessive epilepsies to the population with epilepsy.

The controversy of birth order as a risk factor for epilepsy: a study from Saudi Arabia

PURPOSE

To evaluate the relationship between people with epilepsy and birth order.

METHODS

A case-control study of 336 epileptics, 15 years and above, and their 1961 full siblings. The data was analysed by birth order and then stratified by sibship size. The 95% confidence interval (CI) for each odds ratio (OR) was obtained. ORs were calculated in the 259 probands in whom the seizure and epileptic syndrome were classifiable against their corresponding 1313 siblings.

RESULTS

The OR in birth order 1 is 2.08 (1.6-2.8) on comparing probands to their unaffected siblings. In birth order 3 the OR was 1.64 (1.2-2.2) and ORs declined as birth order increased. The chi-square test for the decline was significant P < 0.05. OR in birth >2 in probands against unaffected sibs was 0.42 (0.2-0.62) in partial seizures and 0.27 (0.17-0.43) in the cryptogenic category, 86% of whom had partial seizures.

CONCLUSION

In spite of some limitations in the study it seemed that there is a significant association between low birth order and the risk of epilepsy when all cases were computed together. The cryptogenic type showed the clearest association between low birth order and the likelihood of epilepsy.

An incident case-control study of first unprovoked afebrile seizures in children: a population-based study of pre- and perinatal risk factors

PURPOSE

The aim of this prospective incident community-based study was to assess the influence of pre- and perinatal risk factors in children in whom an unprovoked afebrile epileptic seizure later developed.

METHODS

From November 1, 1985, until June 30, 1987, 75 children aged 0-15 years with a first unprovoked afebrile seizure were identified. After exclusion of cases with neonatal seizures (n = 14), two controls per case were selected from the same province in northern Sweden matched by age and sex. Files from maternity wards and pediatric clinics could be traced for 58 cases and 109 controls. These formed the study group.

RESULTS

In the univariate analysis, the risk for an unprovoked afebrile seizure was significantly elevated for birth order (OR = 9.3; CI, 2.2-39), vaginal bleeding (OR = 17; 95% CI, 3.5-85), onset of hypertension during pregnancy (OR = 4.8; CI, 1.3-17), cesarean section (OR = 18; 95% CI, 3.7-88), short or long gestational age (OR = 6.7; 95% CI, 2.0-22), and an Apgar score < or =6 at any time (OR = 3.8; 95% CI, 1.2-12). None of these six factors was present in 48.3% of the cases and 89% in the controls. A combination of two or more risk factors found to be significant in the univariate analysis showed a pronounced increased risk for seizures (OR = 19; 95% CI, 5.6-65). In the multivariate analysis, the following characteristics remained statistically significant: vaginal bleeding, gestational age, and Cesarean section. Furthermore, smoking also was identified as a risk factor in the multivariate analysis (OR = 3.4; 95% CI, 1.1-10).

CONCLUSIONS

Both pre- and perinatal factors may be associated with later development of epileptic seizures in children. However, in many of the cases, no such factors were identified.

Early predictors of intractability in childhood epilepsy: a community-based case-control study in Copparo, Italy

OBJECTIVES

To identify early predictors of intractability in childhood and adolescence epilepsy.

MATERIALS AND METHODS

We carried out a community-based case-control study using the incidence cohort of epileptic patients living in the district of Copparo, in the province of Ferrara, Italy. The comparative study was performed in 31 cases and 95 controls. Cases were patients who averaged at least 1 unprovoked seizure per month during an observational period of at least 2 years. Controls were subjects having achieved remission for at least 5 years regardless of current therapy.

RESULTS

Onset at age <1 year, remote symptomatic etiology and high frequency of seizures before therapy were found to be independent early predictors of intractability.

CONCLUSION

Our study suggested that the risk of developing intractable epilepsy may, to some extent, be predicted at the time of initial diagnosis in children with early-onset epilepsy of remote symptomatic etiology, especially if seizure propensity is initially high.

A case control study and one year follow-up of registered epilepsy cases in a resettlement colony of North India, a developing tropical country

A population-based case control study and monthly follow-up of 121 registered epilepsy cases was conducted during 1995-1997 in a resettlement colony of Chandigarh, India. History of various tentative risk factors, e.g. trauma, febrile seizures, family history of seizures, alcohol intake and other possible causes was elicited. An age- and sex-matched control was selected from the neighbouring families for each case. A discordant pair analysis was done for matched case/controls. History of head injury, febrile seizures and developmental delay was observed exclusively in cases (none present in controls). Odds for epilepsy were higher among people who had positive family history (O.R.= 2.1, chi2 = 5.5, C.I. = 1.1-4.3). All cases were followed up and interviewed for history of seizures and drug intake. Fourteen cases could not be followed up completely. Ninety-four (88%) of the remaining 107 cases did not have any seizures during the follow-up. Of them, 70 (75%) patients were not on medication, 13 patients were on phenytoin and 11 patients received phenobarbitone. Thirteen cases reported seizures during the follow-up. Four patients out of the latter had mental retardation and were not on medication. Cumulative incidence of epilepsy was estimated to be 0.6/1000 person-year exposure.

Familial occurrence of epilepsy in children with newly diagnosed multiple seizures: Dutch Study of Epilepsy in Childhood

PURPOSE

To study the familial occurrence of epilepsy in children with newly diagnosed multiple unprovoked seizures.

METHODS

Between August 1988 and September 1992, 462 children with two or more unprovoked seizures were included in the prospective Dutch Study of Epilepsy in Childhood. Seizures and epilepsy syndromes of probands were classified according to the International Classifications. Probands with at least 1 first-degree relative with epilepsy were selected. Seizures and syndromes of their relatives were classified using medical files and telephone interviews.

RESULTS

In 42% of the probands, the epilepsy was classified as localization-related, in 57% as generalized, and in 1% as undetermined whether focal or generalized. The 47 (10.2%) children with at least 1 first-degree relative with epilepsy less frequently had localization-related epilepsy (23%) and more often had generalized epilepsy (77%) as compared with the total group of probands. Fifty-eight first-degree and 21 other relatives had epilepsy. Thirty-three of the 40 (83%) first-degree relatives with idiopathic or cryptogenic epilepsy had the same seizure type as the proband, but detailed information about their seizures was sometimes difficult to obtain. Of the 12 first-degree relatives with epilepsy syndromes classifiable according to the International League Against Epilepsy (ILAE) 7 (58%) had the same syndrome as the proband.

CONCLUSIONS

In 10% of children with newly diagnosed epilepsy, the condition is familial. Relatively more often, these children have generalized epilepsy syndromes as compared with children with a negative family history. Most of the relatives with idiopathic or cryptogenic epilepsy had the same seizure type as the proband. These findings confirm the role of genetic factors in the pathogenesis of epilepsy.

Epilepsy, vagal nerve stimulation by the NCP system, mortality, and sudden, unexpected, unexplained death

PURPOSE

To determine rates of all-cause mortality and of sudden, unexpected, unexplained deaths in epilepsy (SUDEP) in a cohort of individuals treated with the Neuro Cybernetic Prosthesis (NCP) System for intractable epilepsy, and; to contrast the NCP experience with other epilepsy cohorts.

METHODS

A cohort of 791 individuals were followed for 1,335 person-years from implantation. Of the total cohort, 120 individuals had their NCP System devices deactivated. The 15 deaths which occurred during NCP System activation were reviewed for SUDEP by a panel. There were three additional deaths and 242.5 person-years of monitoring after deactivation.

RESULTS

The standardized mortality ratios for NCP System were 5.3, 95% confidence interval (CI) 3.0-8.7; and for the time period after device deactivation, 4.4, 95% CI 0.9-12.8. Six of the deaths during stimulation were considered definite or probable SUDEP and two as possible SUDEP. Seven were not considered to be SUDEP. The incidence of definite/probable SUDEP was 4.5 per 1,000 person-years and 6.0 per 1,000 person-years for definite/probable/possible SUDEP.

CONCLUSIONS

The mortality rates and standardized mortality ratios are comparable with studies of young adults with intractable epilepsy who were not treated with NCP System. These SUDEP rates are not significantly different from those reported in the recent studies of lamotrigine (LTG), gabapentin (GBP), and tiagabine (TGB). The higher rates of SUDEP in the NCP System cohort, as compared with recent drug trials, presumably is explained by the selection of relatively higher-risk patients for the NCP System device.

Prognostic factors for recurrence of a first seizure during childhood

This study was designed with the objective of evaluating the chance of recurrence in our area and to answer questions regarding prognostic factors capable of helping in the management of the first seizure in childhood. One hundred and thirty six children from 1 month to 12 years of age seen at the Pediatric Emergency Division of Hospital de Clínicas de Porto Alegre because of a first seizure with or without triggering factors were included in the study. The follow-up included 121 children. We concluded that family history of seizures, presence of triggering factors at first event, seizure type, seizure duration and paroxysmal electroencephalographic abnormalities were predictive factors for seizure recurrence. The recurrence in this sample was 36.36% during the study. Cumulative recurrence risks were 14.88%, 23.14%, 28.93%, 33.06% and 35.54% to 3, 6, 9, 12 and 15 months, respectively.

Tiagabine: the safety landscape

Tiagabine (TGB) hydrochloride is a potential new antiepileptic drug (AED) undergoing clinical development. Experience in humans amounts to 1,810 patient-years of exposure. TGB was found to be tolerated in an integrated safety analysis of five double-blind, add-on therapy trials involving approximately 1,000 patients with epilepsy with difficult-to-control seizures with existing AEDs. Discontinuation resulting from adverse events were infrequent, occurring in 15% of patients receiving TGB compared to 5% receiving placebo. The most frequently reported adverse event was dizziness, which was usually transient and did not require medical intervention. Adverse events that were statistically significantly more common with TGB than placebo were dizziness, asthenia, nervousness, tremor, diarrhea, and depression (not major depression). Adverse events were usually mild to moderate in severity and transient, and most were associated with dose titration. The incidence, type, and severity of adverse events in long-term studies were comparable with those in short-term studies. Serious adverse events were uncommon and no idiosyncratic events were reported.