AIMS: To examine causes, comorbidities, and treatment outcomes in new-onset focal seizures in children and identify clinical associations for aetiology and drug resistance.

METHODS: Data was gathered from patients aged one month to 18 years presenting with new-onset focal seizures at Children’s Hospital Westmead between 2018 and 2022. Data included seizure aetiology, neurodevelopmental comorbidities, investigations, anti-seizure medications and follow-up outcomes. Logistic regression was used to identify predictors of drug resistance and medication effectiveness.

RESULTS: Sixty-five children were identified with median age of 4.9 years (Interquartile Range 1.8 – 8.0 years). The most common aetiologies were genetic self-limited (22%), structural (18%) and unknown (40%). Children with known aetiology were likely to have explosive-onset seizures, abnormal Magnetic Resonance Imaging and focal neurological deficit (p<0.05). 50% of the total cohort had neuro-comorbidities. 95% of patients developed epilepsy, where 21% were drug resistant with a mean follow-up of 2.2 years. Multivariable logistic regression revealed drug resistance risk increased with multiple neuro-comorbidities (Odds Ratio (OR) 7.26; 95% Confidence Interval (CI) 1.46 – 59.4; p=0.029). After a minimum 1-year follow-up and neuro-comorbidities adjustment, the strongest contributors for therapeutic responsiveness were carbamazepine (OR 17.4; 95%CI 4.24 – 96.4; p<0.001) followed by levetiracetam (OR 4.21; 95%CI 1.19 – 16.5; p=0.031), whereas clobazam was associated with no responsiveness (OR 0.09; 95%CI 0.01 – 0.17; p=0.018).

CONCLUSION: Our study highlights the prevalence of secondary aetiology, neuro-comorbidities and drug resistance in new-onset focal seizures in children, which has significant treatment implications. Seizures with unknown causes require further investigation for improved interventions.

Byoung Chan Lee
The University of Sydney
Australia

Russell Dale
The Children's Hospital at Westmead
Australia

Elizabeth Barnes
The University of Sydney
Australia

Shekeeb Mohammad
The Children's Hospital at Westmead
Australia

Chong Wong
Westmead Hospital
Australia

Sachin Gupta
The Children’s Hospital at Westmead
Australia

Deepak Gill
The Children’s Hospital at Westmead
Australia

Kavitha Kothur
The Children’s Hospital at Westmead
Australia