New-onset unprovoked seizures in a cohort o f children in South India: Application of the new ILAE 2014 definition of epilepsy

Objective: To study the application of International League Against Epilepsy (ILAE) 2014 definition of epilepsy in children with new-onset unprovoked seizure. Methods: The study cohort included 7,408 children accessing Government Primary Schools in a province in south India. They were followed up for new-onset unprovoked seizures through first to sixth grade (January 2006 to December 2012). At the time of first visit the following data was collected: demographic data, age of onset, history of febrile seizures, family history of seizures, seizure semiology and neurologic examination. All children had EEG, and plain and contrast brain. Results: Of the 58 children with new-onset epileptic seizures during the study period, 37 had new-onset unprovoked seizures: focal onset seizures in 13 (30%); generalized onset seizures in 7 (19%); and unknown onset in 17 (46%). Of these children, 30 met the new ILAE 2014 definition of epilepsy, 20 (66.6%) children received the diagnosis of epilepsy after first seizure: eleetro-clinical genetic epilepsy syndromes in 11 (36.7%) and epilepsy due to structural cause in 9 (30%). In the remaining 10 (33.3%) children diagnosis of epilepsy was established after second unprovoked seizure during follow-up study period. Focal or generalized interictal epileptiform discharges in the EEG and normal CT were associated with the diagnosis of genetic epilepsy syndromes and abnormal neuroimaging and normal EEG were associated with the diagnosis of epilepsy with structural lesion with enduring predisposition for recurrent seizure. The type of epilepsies seen in this cohort was the epilepsies seen in this age group. Conclusion: This study shows that with the new ILAE 2014 definition of epilepsy in a cohort of children in South India, four fifth of new-onset unprovoked seizures received the diagnosis of epilepsy; a third each from structural cause, epilepsy syndrome, and second seizure.