Aug. 9, 2000 -- Some good news for worried parents: Most kids who have an unexplained seizure will never have another, according to a new study. The bad news, however, is that if a second seizure does occur -- and does so within 6 months of the first -- they are more likely to have several more. They may, in fact, have epilepsy.
"We are absolutely not talking about febrile, or fever-induced, seizures here, which are relatively harmless," says epilepsy expert Shlomo Shinnar, MD, PhD, who led the 16-year-long, government-funded study. Rather, he tells WebMD, the seizures at issue are those that crop up for no apparent reason. Most common in children born with brain damage or who have had a head injury, these so-called "unprovoked seizures" also strike otherwise perfectly healthy babies and kids.
Shinnar is professor of neurology and pediatrics at Albert Einstein College of Medicine and director of the Comprehensive Epilepsy Management Center at Montefiore Medical Center in the Bronx, N.Y. His team looked at more than 400 children who'd had an unprovoked seizure between the age of 1 month and 19 years. They collected information on when the first seizure or flurry of seizures struck, how long it lasted, and how many took place within a 24-hour period.
The researchers also took a medical history for each child and performed a thorough physical examination, including an EEG. After the initial assessment, they called each child's parents every 3 months, to see if additional seizures had occurred. "The bottom line was that less than half of them had a second seizure," Shinnar tells WebMD.
But of the 182 children who did have a second seizure, roughly 70% had at least one more after that. About 100 of those had a fourth seizure, and 50 had a total of 10 or more, albeit over a period of 10 years. Those who had the second seizure within 6 months of the first were the most likely to have a third, says Shinnar.
"As many as 1 in 25 children will have an unprovoked seizure," says Tallie Z. Baram, MD, PhD, who reviewed the paper for WebMD. "But there is a big difference between a child who has a seizure and a child who has epilepsy."
Epilepsy, she explains, is not a true disease, but rather the chronic symptom of an underlying, little-understood brain disorder. "Essentially, a part of the brain creates abnormal activity that manifests as a seizure," says Baram, professor of neurological sciences, pediatrics, and anatomy and neurobiology at the University of California, Irvine.
Although epilepsy has no cure, several medications are available to control the seizures. But parents and doctors should weigh the pros and cons carefully before giving such medication, says Shinnar, because "all drugs that suppress abnormal brain activity will also interfere to some degree with normal brain activity."
For some kids, he says, "having another seizure may not be worse than being on daily medication."
That's true, says Baram, if the risk of a future seizure is only 50%.
"But what if 5-year-old Johnny has that seizure while crossing the street unsupervised or taking a bath?" she says. "If a child has two seizures within 6 months, I'd tell the parent that the likelihood is very high that the child will have another." And while seizures early in life do not hurt the brain, she says, "they can be really, really scary."
But Shinnar feels that kids run a relatively low risk of being seriously injured during a seizure and should probably stay off medication unless it is absolutely necessary. Plus, he tells WebMD, "70% of kids with epilepsy who do not have mental retardation or cerebral palsy will eventually outgrow their seizures with or without treatment."
This portion of the ongoing study looked specifically at seizures, says Shinnar. His team is now assessing how these children have done in school, at work, in marriage, and in life in general. "We want to see the long-term impact on life," he says. "That's the next phase of research."
The paper appears in the August issue of Annals of Neurology.