New-Onset Afebrile Seizures in Infants Are Generally Brief, but Often Recurrent

From Reuters Health Information

NEW YORK (Reuters Health) Feb 02 - New-onset afebrile seizures in infants are usually brief, but they often recur, and babies who have them should probably be admitted for observation, according to an article in the January 12th issue of Neurology.

"Epilepsy in infants and young toddlers is not well characterized even though one third of all childhood epilepsy begins in this age group," senior author Dr. William Davis Gaillard, of Children's National Medical Center, Washington, DC, told Reuters Health by email.

Dr. Gaillard and his colleagues analyzed data on 317 infants (newborn to 24 months) with new-onset afebrile seizures, including results of CT scans that were done in 298 (94%) patients, EEGs from 286 (90.2%), and MRI in 182 (57.4%).

Nearly half of the infants were having partial seizures. Evidence for primary generalized seizures was rare. The researchers note that only 6 infants without partial features had generalized epileptiform discharges.

Overall, 71% of infants had more than one seizure upon presentation, and 38% presented with 5 or more.

Seizures tended to be brief, with 74% lasting no more than 5 minutes and 44% lasting less than 1 minute. Only 8.5% lasted more than 20 minutes.

Half of the EEGs were abnormal, as were a third of the CT scans and more than half of the MRIs. Nine percent of babies who had CT scans (26% of those with abnormal CT scans) required acute medical management.

One-third of normal CTs were associated with abnormal MRIs, but in only one case (a baby with postoperative seizures) was acute medical management altered.

The most common MRI abnormality was cerebral dysgenesis (p < 0.05).

"This study should provide necessary information for revising guidelines for care of infants with new-onset epilepsy," Dr. Gaillard noted.

"Based on our data all infants...with new-onset seizures should undergo acute neuroimaging, preferably with MRI (as nearly all infants will have focal onset seizures)," he said. "As a substantial proportion of children will have recurrent seizures close to presentation, a strong argument can be made for close observation (in hospital) for these infants."

Neurology 2010;74:150-156.