Predictors of etiology and drug resistance in children with new‐onset focal seizures

TL;DR

This study identifies factors that predict the cause and drug resistance in children with new-onset focal seizures.

Contribution

The study provides new insights into clinical predictors of etiology and drug resistance in pediatric focal seizures.

Findings

Known etiologies like genetic, structural, and inflammatory causes are strong predictors of drug resistance.

Younger age at onset and abnormal neuroimaging are associated with known seizure causes.

Explosive seizure-onset and focal neurological abnormalities are linked to identifiable etiologies.

Abstract

To examine the clinical features of new‐onset focal seizures in children and investigate clinical associations and predictors of underlying etiology and drug resistance.

Data were gathered from The Children's Hospital at Westmead admissions for patients aged 1 month to 18 years who presented with new‐onset focal seizures between 2018 and 2022 (n = 140). Seizure characteristics, etiology, clinical comorbidities, investigations, and antiseizure medications were analyzed. Clinical associations between etiologies and comorbidities/treatment outcomes were investigated using nonparametric tests and hierarchical cluster analysis. Multivariable logistic regression was performed to identify predictors of drug resistance.

The median age of seizure onset was 4.7 years (IQR 1.9–8.1). The etiologies included unknown (n = 53, 39%) followed by structural (n = 36, 26%), self‐limited childhood focal epilepsy (n = 21, 15%), genetic (n = 12, 9%), inflammatory (n = 12, 9%), and metabolic (n = 3, 2%). The explosive seizure‐onset seizures (p = 0.04), focal neurological abnormalities (p = 0.04), younger age at seizure onset (p = 0.01), abnormal neuroimaging findings (p < 0.001), and drug resistance (p < 0.001) were associated with known etiology. Regression analysis showed the drug resistance risk increased with the presence of known genetic (OR 6.7; 95% CI 1.6–31.8), structural (OR 6.4; 95% CI 2.3–19.5), and inflammatory (OR 4.6; 95% CI 1.0–21.2) etiologies.

Our study examines the important associations and predictors of etiology and drug resistance in children with new‐onset focal seizures. The significance of known etiologies as risk factors for drug resistance promotes the need for improved monitoring and etiology‐driven treatment.

This study looked at children who had focal seizures for the first time. In many cases, the cause was unknown, but a large portion was linked to structural brain changes, childhood epilepsies that usually resolve, or genetic, inflammatory, and metabolic conditions. Children with a known cause, especially genetic, structural, or inflammatory, were more likely to have seizures that did not improve with anti‐seizure medications. Identifying the cause early can help doctors choose better treatments and provide closer monitoring for patients.

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