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SUMMARYA first unexplained seizure is a common clinical problem; up to 5% of the population will experience an afebrile seizure during their lifetime.This study was designed to assess the recurrence rate after a first unprovoked afebrile seizure in Egyptian children and the risk factors associated with the recurrence. Eighty patients with age ranging from one year to eighteen years who met our inclusion criteria were selected from outpatient clinics of Neurology Department of Zagazig University Hospitals. In the period between October 2003 and January 2005, all of these patients had an initial unprovoked afebrile seizure.All the patients were subjected to detailed medical and neurological history taking, complete general & neurological examinations to detect any focal neurological deficit or general medical illness and investigations which included laboratory investigations (complete blood count, urine analysis, stool analysis, liver function tests, kidney function tests, blood glucose level), Electoencephalography (EEG) and Computed Tomography (CT).These patients were followed up for one year or seizure recurrence. After the one year follow-up period, 23 patients were withdrawn from the study because of loss or starting treatment, before recurrence. Fifty seven patients had completed the study (35 males and 22 females). Thirty three patients were in their first decade of life, while 24 patients were in their second one. 24 patients had their first seizure at night and 33 patients had their first one at daytime. The type of seizure in 50 patients was generalized while it was partial in only 7 patients. Family history of epileptic seizure in first degree relative was present in only 14 patients while 43 patients informed the opposite. EEG records revealed normal activity in 23 patients, focal epileptic activity in 11 patients and generalized epileptic activity in 23 patients. The age, sex, type of initial seizure, time of day at which the initial seizure occurred and history of epileptic seizures in first degree relatives and EEG records were evaluated as risk factors might contribute to seizure recurrence.The following results were obtained:• After one year follow-up period 37 patients had a seizure recurrence with an overall recurrence rate of 64.91%. Most of the recurrences occurred in the first 6 months (30 of 37 patients, 81.08%) mostly in the first 3 months (25 of 37 patients, 67.56%).• The recurrence in patients who were in their first decade of life was higher (72.72%) than that in patients who were in their second decade (54.16%) but this difference was not significant.• There is non- significant relation between sex of the patient and the risk of recurrence, although the recurrence was higher in males (68.57%) than in females (59.09%).• The occurrence of the first seizure at night i.e. between 11 pm and 8 am is a significant risk factor, as the recurrence among patients who had experienced their first seizure at night was significantly higher (83.33%) than recurrence among patients who had experienced their first seizure at daytime i.e. between 8 AM and 11 PM (51.51%).• Type of the first seizure had not affect the recurrence significantly, however patients with partial seizure had a recurrence rate (71.42%) higher than patients with general one (64%).• Patients with history of epileptic seizures in a first degree relative had recurrence in a rate of 78.5% which was higher than those without history of seizure in a first degree relative (60.46%). However, this difference did not reach significance.• Patients with Pathologic EEG had higher recurrence (70.58%) than those with normal records (56.52%). Also, patients with focal epileptic EEG had a higher recurrence rate (81.81%) than patients with generalized records (65.21%) but all these differences were non- significant.From these results, one can conclude that the cumulative probability of seizure recurrence after an initial unprovoked afebrile seizure in Egyptian children after one year is 64.91% and the risk of seizure recurrence is at its peak within the first 3 months after the first seizure and it declines with time. We also conclude that the occurrence of the first seizure at night was a significant risk factor for recurrence. While male sex, first decade of life, partial first seizure, presence of family history of epileptic seizure in first degree relative and pathological activities in EEG especially focal epileptic activities were non-significant factors which affect the rate of recurrence.We might recommend that Anti Epileptic Drugs (AEDs) might be initiated after the first unprovoked afebrile seizure in any male child in his first decade of life presented within three months after partial first seizure and has a history of seizure in first degree relative with pathological EEG records, especially when the first seizure occurred at night time.
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