Are Afebrile Seizures Associated With Minor Infections A Single Seizure Category? A Hospital-based Prospective Cohort Study On Outcomes Of First Afebrile Seizure In Early Childhood

Objective: To explore if afebrile seizures associated with minorinfections are a single category of seizure, or a set of different kinds ofseizures.Methods: We conducted this prospective cohort study on three kindsof first afebrile seizure-first afebrile seizure associated with gastrointestinalinfection (AS-GI), first afebrile seizure associated with non-gastrointestinalinfection (AS-nGI) and first unprovoked seizure (US). The Kaplan–Meierestimate risks of recurrent seizures were analyzed and compared pairwise.The characteristics of recurrent seizures were also compared pairwise.Results: The Kaplan–Meier estimate risks of recurrent seizure at2years of the AS-GI, AS-nGI and US groups were6.9%,23.7%and37.8%,respectively. The pairwise differences were significant between the US andAS-GI groups (P<0.001) and between the AS-nGI and AS-GI groups(P=0.001), but not significant between the US and AS-nGI groups (P=0.066). Among unprovoked subsequent seizures in patients withrecurrence, the pairwise differences were significant between the AS-GIand US groups (P<0.001) and between the AS-GI and AS-nGI groups(P=0.005), but not significant between the US and AS-nGI groups(P=0.417).Conclusions: Afebrile seizures associated with minor infections areindeed of two distinguishable kinds: AS-GI, if free of risk factors such as afamily history of epilepsy, had a better prognosis and should be categorizedas an acute symptomatic seizure, whereas patients with first AS-nGI, likepatients with first US, may have recurrent unprovoked seizures, whichsuggests this category’s essential difference fromAS-GI.