Evaluation of pediatric patients in new-onset seizure clinic (NOSc)

• Published in: Epilepsy & behavior Vol. 112; p. 107428
• Main Authors: Kim, Seunghyo, DeGrauw, Ton, Berg, Anne T., Hass, Kristen B., Koh, Sookyong
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2020
• Subjects: Antiepileptic drugs; Child; Electroencephalography; Epilepsy - diagnosis; Epilepsy - drug therapy; Epilepsy - epidemiology; Epilepsy, Generalized; First time seizure; Humans; New-onset epilepsy; Nonepileptic events; Retrospective Studies; Seizures - diagnosis; Seizures - epidemiology; CT; First time seizure; NOS; PCPs; New-onset epilepsy; Nonepileptic events; MRI; EEG; ASM; Antiepileptic drugs; ED; NEE
• ISSN: 1525-5050; 1525-5069
• DOI: 10.1016/j.yebeh.2020.107428

We evaluated the clinical and demographic features of children presenting with unprovoked seizures at a regional new-onset seizure clinic (NOSc). We retrospectively reviewed charts of 492 consecutive patients evaluated in the NOSc at the Childrne’s Healthcare of Atlanta Nonepileptic events (NEE) were diagnosed in 102 (24%) and epileptic seizures in the remaining 326 (76%). Patients with NEE were younger than patients with epileptic seizure (5.0 vs. 7.4 years). Except for headache which occurred more frequently in NEE (14% vs. 6%), frequencies of comorbidities were similar in groups with NEE and epileptic seizure. Electroencephalogram (EEG) was performed in 98%, and finding was abnormal in 51%. Brain magnetic resonance imaging (MRI) was performed in 55%, and finding was abnormal in 15%. An electroclinical epilepsy syndrome was diagnosed in 42%. Antiseizure medication was started in 25% with first seizure and in 77% with recurrent seizures. For children with newly-presenting seizures, a regional NOSc provided efficient, timely diagnosis and appropriate evaluations and treatment. Timely recognition of NEE resulted in fewer unnecessary evaluations and treatment for a quarter of referred patients whereas identification of the specific types of seizures and epilepsy allowed appropriate use, including deferral, of neuroimaging and guided treatment selection. •A regional new-onset seizure (NOS) clinic can efficiently and rapidly accommodate a large number of patients.•Accurate differentiation between nonepileptic events and epileptic seizures ensures appropriate procedures and medications.•The same day EEG resulted in accurate identification of seizure and epilepsy type and selection of appropriate therapy.•For children with NOS, discontinuation of routine CT in the emergency department in favor of MRI is advised.•Brain MRI in place of head CT for focal seizures would contain costs and result in greater diagnostic yield.