Work

Predictors of etiology and drug resistance in children with new‐onset focal seizures

Year: 2026

Type: article

Abstract: OBJECTIVE: To examine the clinical features of new-onset focal seizures in children and investigate clinical associations and predictors of underlying etiology and drug resistance. METHODS: Data were gathered from The Children's Hospital at Westmead admissions for patients aged 1 month to 18 years who presented with new-onset focal seizures between 2018 and 2022 (n = 140). Seizure characteristics, etiology, clinical comorbidities, investigations, and antiseizure medications were analyzed. Clinical associations between etiologies and comorbidities/treatment outcomes were investigated using nonparametric tests and hierarchical cluster analysis. Multivariable logistic regression was performed to identify predictors of drug resistance. RESULTS: The median age of seizure onset was 4.7 years (IQR 1.9-8.1). The etiologies included unknown (n = 53, 39%) followed by structural (n = 36, 26%), self-limited childhood focal epilepsy (n = 21, 15%), genetic (n = 12, 9%), inflammatory (n = 12, 9%), and metabolic (n = 3, 2%). The explosive seizure-onset seizures (p = 0.04), focal neurological abnormalities (p = 0.04), younger age at seizure onset (p = 0.01), abnormal neuroimaging findings (p < 0.001), and drug resistance (p < 0.001) were associated with known etiology. Regression analysis showed the drug resistance risk increased with the presence of known genetic (OR 6.7; 95% CI 1.6-31.8), structural (OR 6.4; 95% CI 2.3-19.5), and inflammatory (OR 4.6; 95% CI 1.0-21.2) etiologies. SIGNIFICANCE: Our study examines the important associations and predictors of etiology and drug resistance in children with new-onset focal seizures. The significance of known etiologies as risk factors for drug resistance promotes the need for improved monitoring and etiology-driven treatment. PLAIN LANGUAGE SUMMARY: This study looked at children who had focal seizures for the first time. In many cases, the cause was unknown, but a large portion was linked to structural brain changes, childhood epilepsies that usually resolve, or genetic, inflammatory, and metabolic conditions. Children with a known cause, especially genetic, structural, or inflammatory, were more likely to have seizures that did not improve with anti-seizure medications. Identifying the cause early can help doctors choose better treatments and provide closer monitoring for patients.

Source: Epilepsia Open

DOI: 10.1002/epi4.70179