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Prevalence and Predictors of Seizure Clusters in Pediatric Patients With Epilepsy: The Harvard-Yale Pediatric Seizure Cluster Study

  • Author Footnotes
    1 Drs. Jafarpour and Fong contributed equally.
    Saba Jafarpour
    Footnotes
    1 Drs. Jafarpour and Fong contributed equally.
    Affiliations
    Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts

    Division of Neurology, Children's Hospital of Los Angeles, Los Angeles, California
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  • Author Footnotes
    1 Drs. Jafarpour and Fong contributed equally.
    Michael W.K. Fong
    Footnotes
    1 Drs. Jafarpour and Fong contributed equally.
    Affiliations
    Department of Neurology, Comprehensive Epilepsy Center, Yale University School of Medicine, New Haven, Connecticut

    TY Nelson Department of Neurology, The Children's Hospital at Westmead, Sydney, Australia

    Westmead Comprehensive Epilepsy Unit, Westmead Hospital, University of Sydney, Sydney, Australia
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  • Kamil Detyniecki
    Affiliations
    Department of Neurology, Comprehensive Epilepsy Center, Yale University School of Medicine, New Haven, Connecticut

    Comprehensive Epilepsy Center, Department of Neurology, University of Miami, Miami, Florida
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  • Ambar Khan
    Affiliations
    Department of Neurology, Comprehensive Epilepsy Center, Yale University School of Medicine, New Haven, Connecticut

    Larkin Community Hospital, South Miami, Florida
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  • Ebony Jackson-Shaheed
    Affiliations
    Department of Neurology, Comprehensive Epilepsy Center, Yale University School of Medicine, New Haven, Connecticut

    VA Connecticut Healthcare System, West Haven, Connecticut
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  • Xiaofan Wang
    Affiliations
    Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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  • Samuel Lewis
    Affiliations
    Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts

    Department of Emergency Medicine, University of Washington, Seattle, Washington
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  • Robert Benjamin
    Affiliations
    Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts

    Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
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  • Marina Gaínza-Lein
    Affiliations
    Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts

    Instituto dr Pediatria, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile

    Facultad de Medicina, Universidad de Chile, Santiago, Chile
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  • Jane O'Bryan
    Affiliations
    Department of Neurology, Comprehensive Epilepsy Center, Yale University School of Medicine, New Haven, Connecticut
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  • Lawrence J. Hirsch
    Affiliations
    Department of Neurology, Comprehensive Epilepsy Center, Yale University School of Medicine, New Haven, Connecticut
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  • Tobias Loddenkemper
    Correspondence
    Communications should be addressed to: Dr. Loddenkemper; Director; Division of Epilepsy and Clinical Neurophysiology; Department of Neurology; Clinical Epilepsy Research; Boston Children's Hospital; Professor of Neurology; Harvard Medical School; 300 Longwood Avenue; Boston, MA 02115, USA.
    Affiliations
    Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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  • Author Footnotes
    1 Drs. Jafarpour and Fong contributed equally.

      Abstract

      Background

      Determine the prevalence of seizure clusters (two or more seizures in six hours), use of rescue medications, and adverse outcomes associated with seizure clusters in pediatric patients with a range of epilepsy severities, and identify risk factors predictive of seizure clusters.

      Methods

      Prospective observational two-center study, including phone call and seizure diary follow-up for 12 months in patients with epilepsy aged one month to 18 years. We classified patients into three risk groups based on seizures within the prior year: high, seizure cluster (two or more seizures within one day); intermediate, at least one seizure but no days with two or more seizures; low, no seizures.

      Results

      One-third (32.3%; high risk, 72.4%; intermediate risk, 30.4%; low risk, 3.1%) of 297 patients had a seizure cluster during the study, including half (46.2%) of the patients with active seizures at baseline (intermediate- and high-risk groups combined). Emergency room visits or injuries were no more likely due to a seizure cluster than an isolated seizure. Rescue medications were utilized in 15.8% of patients in the high-risk group and 19.2% in the intermediate-risk group. History of status epilepticus (adjusted odds ratio [aOR], 2.13; confidence interval [CI], 1.09 to 4.16]), seizure frequency greater than four per month (aOR, 4.27; CI, 1.92 to 9.50), and high-risk group status (aOR, 6.42; CI, 2.97 to 13.87) were associated with greater odds of seizure cluster.

      Conclusions

      Seizure clusters are common in pediatric patients with epilepsy. High seizure frequency was the strongest predictor of clusters. Rescue medications were underutilized. Future studies should evaluate the applicability and effectiveness of these medications for optimization of pediatric seizure cluster treatment and reduction of seizure-related emergency department visits, injuries, and mortality.

      Keywords

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