Diagnosis of the first seizure-like events in children from third-tier cities in southwestern China: a retrospective cohort study

BACKGROUND: Seizure-like events present a diagnostic challenge for paediatricians, particularly in third-tier cities in southwestern China. Although government initiatives have improved the accuracy of epilepsy diagnosis, substantial disparities persist between southwestern and eastern China. The aims of this study were to investigate clinical characteristics and prognosis of children with seizure-like events in resource-limited cities in southwestern China and to identify factors associated with future epilepsy. METHODS: This was a retrospective cohort study. We retrospectively reviewed the medical records of 519 children aged 23 days to 13.5 years who experienced seizure-like events. Demographic information, seizure characteristics, electroencephalograph (EEG) and brain MRI were collected. Epilepsy was diagnosed according to the International League Against Epilepsy criteria. Multivariate logistic regression was performed to determine independent predictors of epilepsy. RESULTS: We enrolled 519 children in our hospital. Forty-five (45/263, 17.1%) patients were first diagnosed with seizures. At the first seizure presentation, 263 patients (50.7%) were diagnosed with epilepsy. The aetiology of these patients with epilepsy was more commonly unknown (166/263, 63.2%), followed by a genetic aetiology (65/263, 24.6%). Normal MRI and EEG findings were observed in 218 (42.0%) and 169 (32.6%) children, respectively. Seizure frequency, positive genetic test results, abnormal brain MRI and abnormal video-EEG were predictive of recurrent febrile seizures. Multivariate analysis revealed that high seizure frequency, abnormal video-EEG findings and structural brain abnormalities are key predictors of subsequent epilepsy in children. CONCLUSIONS: Although we aimed to identify risk factors applicable to resource-limited areas, we found that only high seizure frequency, abnormal video-EEG findings and structural brain MRI abnormalities independently predicted a subsequent diagnosis of epilepsy. These findings underscore the need for targeted paediatrician training, as well as increased financial investment in resource-limited rural areas to improve hospital infrastructure, in order to help reduce the epilepsy treatment gap.