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

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

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.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Age Factors
  • Cerebral Palsy / epidemiology
  • Child
  • Cognition Disorders / epidemiology
  • Cognition Disorders / etiology
  • Epilepsy / diagnostic imaging
  • Epilepsy / epidemiology*
  • Female
  • Gestational Age
  • Head / pathology
  • Humans
  • Incidence
  • Infant, Extremely Premature*
  • Male
  • Neuropsychological Tests
  • Prospective Studies
  • Retrospective Studies
  • Seizures / diagnostic imaging
  • Seizures / epidemiology*
  • Ultrasonography