- 作者：Chellamani Harini ; Kanwaljit Singh ; Masanori Takeoka ; Isha Parulkar ; Ann Marie Bergin ; Tobias Loddenkemper ; Sanjeev V. Kothare
- 关键词：Seizure frequency ; Predictors of seizure occurrence ; Pre-surgical monitoring
- 刊名：Seizure
- 出版年：2013
- 出版时间：October, 2013
- 年：2013
- 卷：22
- 期：8
- 页码：640-646
- 全文大小：670 K
Purpose
Long-Term-Monitoring (LTM) is a valuable tool for seizure localization/lateralization among children with refractory-epilepsy undergoing pre-surgical-monitoring. The aim of this study was to examine the factors predicting occurrence of single/multiple seizures in children undergoing pre-surgical monitoring in the LTM unit.Methods
Chart review was done on 95 consecutive admissions on 92 children (40 females) admitted to the LTM-unit for pre-surgical workup. Relationship between occurrence of multiple (¡Ý3) seizures and factors such as home seizure-frequency, demographics, MRI-lesions/seizure-type and localization/AED usage/neurological-exam/epilepsy-duration was evaluated by logistic-regression and survival-analysis. Home seizure-frequency was further categorized into low (up-to 1/month), medium (up-to 1/week) and high (>1/week) and relationship of these categories to the occurrence of multiple seizures was evaluated. Mean length of stay was 5.24 days in all 3 groups.
Results
Home seizure frequency was the only factor predicting the occurrence of single/multiple seizures in children undergoing presurgical workup. Other factors (age/sex/MRI-lesions/seizure-type and localization/AED-usage/neurological-exam/epilepsy-duration) did not affect occurrence of single/multiple seizures or time-to-occurrence of first/second seizure.
Analysis of the home-seizure frequency categories revealed that 98 % admissions in high-frequency, 94 % in the medium, and 77 % in low-frequency group had at-least 1 seizure recorded during the monitoring. Odds of first-seizure increased in high vs. low-frequency group (p = 0.01). Eighty-nine percent admissions in high-frequency, 78 % in medium frequency, versus 50 % in low-frequency group had ¡Ý3 seizures. The odds of having ¡Ý3 seizures increased in high-frequency (p = 0.0005) and in medium-frequency (p = 0.007), compared to low-frequency group. Mean time-to-first-seizure was 2.7 days in low-frequency, 2.1 days in medium, and 2 days in high-frequency group. Time-to-first-seizure in high and medium-frequency was less than in low-frequency group (p < 0.0014 and p = 0.038).
Conclusion
Majority of the admissions (92 % ) admitted to the LTM-unit for pre-surgical workup had at-least one seizure during a mean length of stay of 5.24 days. Home seizure-frequency was the only predictor influencing occurrence of single/multiple seizures in the LTM unit. Patients with low seizure-frequency are at risk for completing the monitoring with less than the optimum number (<3) of seizures captured.