Abstracts

Recurrence of single non-provoked epileptic seizure is generally studied in tertiary hospitals where the Universities are based. The aim of this paper is to report the evolution of first non-provoked epileptic seizure in children from the community followed in a secondary care University hospital in Sao Paulo, SP, Brazil., We performed pediatric neurological prospective and consecutive follow-up of 51 children with non-provoked single epileptic seizure, aged 17 months to 15 years (mean 8.4) referred from the Pediatric emergency sector of the University of Sao Paulo Hospital, a secondary care regionalized unit which receives patients from Butanta district in Sao Paulo city, Brazil. All have performed brain CT and EEG. The EEG was read by the same neurologist who took care of the patients in the out-patient unit., There were 29 boys and 22 girls. Seizures occurred in wakefulness in 29, sleep in 18, and on arousal in 4. Only one patient had a seizure lasting more than 10 min and 5 had multiple seizures ([gt]1/24h). Focal seizures occurred in 29, generalized in 14, and not classified in 8. Only one had had previous febrile seizures (FS); 5 had relatives (first grade) with epilepsy, and 2 with FS. Mild mental retardation was present in 3. EEG was abnormal in 36, showing focal paroxysms in 20 (rolandic in 6, parietotemporal 5, occipital 3, frontal 3, and hemispheric in 2), multifocal in 1 (after a while, rolandic) and generalized in 9. Two had abnormal brain CT (arachnoid cist and non specific abnormality, not confirmed by MRI). Electroclinical analysis revealed idiopathic generalized epileptic syndrome in 8 (7 juvenile absence and 1 juvenile myoclonic epilepsy) who received VPA; CBZ was prescribed in 2 patients because of very frequent frontal discharges; 4 patients had had remote seizure and were medicated; 5 were receiving DAE since the emergency unit and the family preferred to keep it; and finally 32 remained without DAE. Eleven of these (34.4%) had seizure recurrence and AED was prescribed. The etiology was idiopathic in 40, symptomatic in 1 (frontal remote encephalic trauma) and cryptogenic in 10 (3 with mild mental retardation and 7 learning disability). The second seizure recurred in a mean time of 80 days (15 days-14 months); risk factors were male sex, focal seizures and occurrence in sleep., Recurrence after non-provoked single epileptic seizure in children from the community was similar to that of tertiary hospitals. This might be due to an inadequate distribution of health professionals in some peripheral areas. There is a need for specialists in these units in order to correctly perform the diagnosis of epileptic syndromes of low remission, such as juvenile absence and myoclonic epilepsies, as well as, to give the patients a better standard care, and consequently decrease the stigma of epileptic seizures in the population.,