Clinical characterization of the pre-ictal state in the pediatric population: A caretaker's perspective

- 21.6% of caretakers report the ability to predict seizures.
- Positive caretaker prediction is associated with earlier age of seizure onset.
- Most common pre-ictal symptoms reported include tired, hazy look, and sleepiness.
- 76.6% of caretakers report at least one seizure precipitant.
- Reliable seizure prediction may open a role for pre-emptive interventions.

The unpredictability of seizures causes distress to patients with epilepsy and their caretakers. To date, no studies have explored seizure prediction specifically in the pediatric population. If the period of time preceding a seizure can be reliably identified, either by child or caretaker, there may be a role for pre-emptive interventions. The aim of this study was to investigate caretaker seizure prediction. A questionnaire was distributed to caretakers of patients with epilepsy. The patients were 0-21 years old and experienced ≥ 1 seizure within the past year. We excluded patients with non-epileptic seizures or daily seizures. One hundred and fifty of 240 questionnaires met criteria. Of these, 32 (21.6%) caretakers indicated a positive report of seizure prediction. Age of seizure onset was earlier in the positive predictive group (3.3 ± 3.3 years) than in the non-predictor group (5.3 ± 4.8 years) (p = 0.01). The most common pre-ictal symptoms reported were being tired, hazy look, and sleepiness. A total of 76.6% of caretakers reported at least one seizure precipitant. The prevalence of positive caretaker seizure prediction in this study is similar to that of seizure self-prediction in adult studies. These findings will be used to design prospective online or electronic diary studies to further investigate the caretaker's, as well as children's, perspectives on seizure prediction. We anticipate that this investigation may lead to novel treatments during times of high seizure risk.