Abstracts

Clinical studies of pediatric epilepsy focus on effects of seizures occurring in the first years of life. Rat pup studies have indicated significant differences in long term effects, including epileptogenicity, of prolonged convulsions induced at different ages. Clinical human studies typically focus on seizures and episodes of status epilepticus (SE) occurring in the age category of [quot]greater than one month and less than one year[quot]. Conclusions vary, although statistics are consistent. Clinical experience and review of refractory pediatric SE cases indicated a high proportion of children with no co-morbid factors and low morbidity who presented with febrile SE around one year of age. Review of previoudsly reported cases to ascertain a peak incidence for benign febrile SE was undertaken. Previously reported cases from the Greater Richmond Metropolitan Area prospective collection of all first SE cases were re-examined. SE and seizure types were defined as described previously (Neurology 46: 1029, 1996). All cases with ages between one month and 17 years of age were reviewed. More detailed examination of incidence was undertaken, with cases grouped by age categories covering three month increments for those four years of age or younger. Subsequently, cases of febrile status were segregated. (These cases had fever or infection, but not meningitis or encephalitis, listed as an etiology. There were no co-morbid features [italic]e.g.[/italic] prior seizures, cerebral palsy, genetic abnormalities, delayed development, prior or ongoing neuorlogic insults.) Review of cases indicated a bimodal distribution of SE in the first two years of life. A large group of children with febrile status accounted for the second peak ( as well as 21% of all cases of SE in the one month to 17 yr age group.) This group had no associated mortality. 61% of febrile status occurred in the 9 month - 18 month age group.[table1] Febrile SE in children with no co-morbid features and low associated morbidity peaks around 9 to 18 months. This group may have particular susceptibility to acute convulsions, but may be less prone to long term sequelae. In recent articles, epidemiologic information is typically stratified into a [quot]less than one year[quot] category. Future studies of seizures and SE in the very young may yield more prognostic information if the age category of [quot]over one month but less than six months[quot] is utilized. (Supported by NIH PO1-NS25630)