Cumulative Incidence of Seizures and Epilepsy in 10-Year-old Children Born Before 28 Weeks Gestation

• Published in: Pediatric neurology 2017-05, Vol.73, p.13-19
• Main Authors: Douglass, Laurie M., M.D, Heeren, Timothy C., PhD, Stafstrom, Carl E., M.D., PhD, DeBassio, William, M.D. PhD, Allred, Elizabeth N., M.S, Leviton, Alan, M.D., M.S, O’Shea, T. Michael, M.D., MPH, Hirtz, Deborah, M.D, Rollins, Julie, M.A, Kuban, Karl, M.D, M.S
• Format: Article
• Language: English
• Subjects: Neurology; Pediatrics
• ISSN: 0887-8994; 1873-5150
• DOI: 10.1016/j.pediatrneurol.2017.05.009

Abstract Objective To evaluate seizures and epilepsy incidence in the first decade of life among children born extremely premature (< 28 weeks gestation). Method In a prospective, multi-center, observational study, 889 of 966 eligible children born 2002-2004 were evaluated at 2 and 10 years for neurological morbidity. Complementing questionnaire data to determine a history of seizures, all caregivers were interviewed retrospectively for post-neonatal seizures using a validated seizure screen followed by a structured clinical interview by a pediatric epileptologist. A second pediatric epileptologist established an independent diagnosis based on recorded responses of the interview. A third epileptologist determined the final diagnosis when evaluators disagreed (3%). Lifetable survival methods were used to estimate seizure incidence through 10 years. Results By age 10 years, 12.2% percent (95% CI: 9.8, 14.5) of children had ≥1 seizure , 7.6% (95% CI 5.7, 9.5) had epilepsy, 3.2% had seizure with fever, and 1.3% had a single, unprovoked seizure. Seizure incidence increased with decreasing gestational age. In more than 75% of children with seizures, onset was after one year of age. Seizure incidence was comparable in both sexes. Two-thirds of those with epilepsy had other neurological disorders. One-third of children with epilepsy were not recorded on the medical history questionnaire. Significance The incidence of epilepsy through 10 years of age among children born extremely premature is approximately 7 to 14-fold higher than the 0.5-1% lifetime incidence reported in the general pediatric population. Seizures in this population are under-recognized, and possibly under-diagnosed, by parents and providers.