Saturday, August 10, 2013

Predicting seizures in children during pre-surgical monitoring

A recent study shows how seizures are predicted in children during pre-surgical monitoring.

Long–Term–Monitoring (LTM) is a valuable tool for seizure localization/lateralization among children with refractory–epilepsy undergoing pre–surgical–monitoring. The aim of this study was to examine the factors predicting occurrence of single/multiple seizures in children undergoing pre–surgical monitoring in the LTM unit. Majority of the admissions (92%) admitted to the LTM–unit for pre–surgical workup had at–least one seizure during a mean length of stay of 5.24 days. Home seizure–frequency was the only predictor influencing occurrence of single/multiple seizures in the LTM unit. Patients with low seizure–frequency are at risk for completing the monitoring with less than the optimum number (<3) of seizures captured.
  • Chart review was done on 95 consecutive admissions on 92 children (40 females) admitted to the LTM-unit for pre-surgical workup.
  • Relationship between occurrence of multiple (≥3) seizures and factors such as home seizure-frequency, demographics, MRI-lesions/seizure-type and localization/AED usage/neurological-exam/epilepsy-duration was evaluated by logistic-regression and survival-analysis.
  • Home seizure-frequency was further categorized into low (up-to 1/month), medium (up-to 1/week) and high (>1/week) and relationship of these categories to the occurrence of multiple seizures was evaluated.
  • Mean length of stay was 5.24 days in all 3 groups.
  • Home seizure frequency was the only factor predicting the occurrence of single/multiple seizures in children undergoing presurgical workup.
  • Other factors (age/sex/MRI-lesions/seizure-type and localization/AED-usage/neurological-exam/epilepsy-duration) did not affect occurrence of single/multiple seizures or time-to-occurrence of first/second seizure.
  • Analysis of the home-seizure frequency categories revealed that 98% admissions in high-frequency, 94% in the medium, and 77% in low-frequency group had at-least 1 seizure recorded during the monitoring.
  • Odds of first-seizure increased in high vs. low-frequency group (p=0.01).
  • Eighty-nine percent admissions in high-frequency, 78% in medium frequency, versus 50% in low-frequency group had ≥3 seizures.
  • The odds of having ≥3 seizures increased in high-frequency (p=0.0005) and in medium-frequency (p=0.007), compared to low-frequency group.
  • Mean time-to-first-seizure was 2.7 days in low-frequency, 2.1 days in medium, and 2 days in high-frequency group.
  • Time-to-first-seizure in high and medium-frequency was less than in low-frequency group (p<0.0014 and p=0.038).
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