title: Redefining outcome of first seizures by acute illness.
abstract: BACKGROUND
  Seizures are common in children, but the causes and recurrence risk for children with a nonfebrile first seizure remain poorly understood.
  
  
  OBJECTIVE
  In a prospective longitudinal study of children who presented with a first-time seizure, we investigated the viral etiology of associated infectious illnesses and sought to determine the risk of recurrent seizures stratified by fever and type of illness.
  
  
  METHODS
  Children (aged 6 months to 6 years) were enrolled at the time of evaluation for their first seizure and followed monthly for up to 5 years. Seizure and illness data were collected through parent interviews and medical-record reviews. Stool, serum, and cerebrospinal fluid collected within 48 hours of the first seizure were evaluated for viral gastrointestinal pathogens.
  
  
  RESULTS
  Of the 117 children enrolled, 78 (67%) had febrile seizures, 34 (29%) had nonfebrile-illness seizures, and 5 (4%) had unprovoked seizures. Children with nonfebrile-illness seizures were more likely than those with febrile seizures to have acute gastroenteritis (47% and 28%, respectively; P = .05). No significant differences in seizure recurrence were found between children with or without a fever at first seizure. Children with acute gastroenteritis at first seizure, regardless of fever, had a lower risk of seizure recurrence compared with children with other acute illnesses (hazard ratio: 0.28; 95% confidence interval: 0.09-0.80).
  
  
  CONCLUSIONS
  Our results confirm the role of gastrointestinal illness as a distinguishing feature in childhood seizures. Children with this distinct presentation have a low rate of seizure recurrence and few neurologic complications.
authors.affiliation: Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA.
authors.forename: Emily T
authors.initials: ET
authors.lastname: Martin
authors.forename: Tara
authors.initials: T
authors.lastname: Kerin
authors.forename: Dimitri A
authors.initials: DA
authors.lastname: Christakis
authors.forename: Heidi K
authors.initials: HK
authors.lastname: Blume
authors.forename: Sidney M
authors.initials: SM
authors.lastname: Gospe
authors.forename: Jan
authors.initials: J
authors.lastname: Vinje
authors.forename: Michael D
authors.initials: MD
authors.lastname: Bowen
authors.forename: Jon
authors.initials: J
authors.lastname: Gentsch
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Zerr
mesh_terms: D000208:Acute Disease; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004569:Electroencephalography; D005260:Female; D005334:Fever / Q000150:complications* / Q000175:diagnosis; D005500:Follow-Up Studies; D005759:Gastroenteritis / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D012640:Seizures / Q000175:diagnosis / Q000209:etiology*; D003294:Seizures, Febrile / Q000150:complications* / Q000175:diagnosis