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Pediatr Neurol. 2017 Aug;73:13-19. doi: 10.1016/j.pediatrneurol.2017.05.009. Epub 2017 May 18.

Cumulative Incidence of Seizures and Epilepsy in Ten-Year-Old Children Born Before 28 Weeks' Gestation.

Author information

1
Department of Pediatrics and Neurology, Boston Medical Center, Boston, Massachusetts. Electronic address: laurie.douglass@bmc.org.
2
Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts.
3
Department of Neurology, Johns Hopkins Hospital, Baltimore, Maryland.
4
Department of Pediatrics and Neurology, Boston Medical Center, Boston, Massachusetts.
5
Harvard Medical School, Boston, Massachusetts; Department of Neurology, Boston Children's Hospital, Boston, Massachusetts.
6
Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina.
7
National Institute of Neurological Disorders and Stroke, Bethesda, Maryland.

Abstract

OBJECTIVE:

We evaluated the incidence of seizures and epilepsy in the first decade of life among children born extremely premature (less than 28 weeks' gestation).

METHOD:

In a prospective, multicenter, observational study, 889 of 966 eligible children born in 2002 to 2004 were evaluated at two and ten years for neurological morbidity. Complementing questionnaire data to determine a history of seizures, all caregivers were interviewed retrospectively for postneonatal 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%). Life table survival methods were used to estimate seizure incidence through ten years.

RESULTS:

By age ten years, 12.2% (95% confidence interval: 9.8, 14.5) of children had experienced one or more seizures, 7.6% (95% confidence interval: 5.7, 9.5) had epilepsy, 3.2% had seizure with fever, and 1.3% had a single, unprovoked seizure. The 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 age ten years among children born extremely premature is approximately 7- to 14-fold higher than the 0.5% to 1% lifetime incidence reported in the general pediatric population. Seizures in this population are under-recognized, and possibly underdiagnosed, by parents and providers.

KEYWORDS:

epilepsy; extreme prematurity; low gestational age; newborn; rate; risk; seizure incidence

[Indexed for MEDLINE]
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