Abstracts

Although the diagnosis of seizures are common in pediatric neurology practice, first presentation is a particularly frightening event for the child and their family members. Accurate differentiation of a seizure from a non-epileptic event, such as convulsive syncope and breath holding is important, as prognosis, life style modifications and social stigma differ between these diagnoses. The goals of this study is to determine (a) the range of diagnoses presenting to a first seizure clinic, and (b) the prevalence of previous seizures in children presenting to a first seizure clinic., 127 children were seen in a tertiary care First Seizure Clinic. Inclusion criteria were age 1 mo [ndash] 17 yrs with an unprovoked event suggestive of seizure. Data collected included referring physician specialty, child[apos]s age, gender, developmental status and clinical diagnosis of epileptologist (non-epileptic vs epileptic). For those with epileptic events, seizure type, syndrome (if identifiable), presumed etiology (idiopathic, cryptogenic, symptomatic), presence of prior afebrile and febrile seizures, provoking factors, family history, pre/perinatal complications and EEG results were recorded., The diagnosis was epileptic in 94 (74%), non-epileptic in 31 (24%) and unclassifiable in 2 (2%). Pediatricians were more likely to refer true epileptic events (92%) than ED physicians (76%) or Family Physicians (65%). Mean age at presentation was 8 years. Fifteen percent of children were developmentally delayed and neurological examination was abnormal in 11%. For those diagnosed with epileptic events, 32 presented with generalized while 62 presented with partial onset seizures. An epilepsy syndrome was identifiable in 15 cases. Thirty eight percent experienced a prior probable seizure which was recognized by the referring physician in only one case. An EEG was done in all children with seizures and was abnormal in 41 %., Diagnostic inaccuracy is common in first seizure. One quarter of children were incorrectly diagnosed as having a seizure while the diagnosis of epilepsy was missed in over 1/3 of children. First seizure clinics conducted by epilepsy specialists is important in the diagnosis, treatment and counseling in this group of children.,