First Seizure in Adult Life

Donselaar, Cees A. van; Geerts, Ada T.; Elwes, Robert; Reynolds, E. H.; Travis, Simon; Plaut, G.S.; Hopkins, Anthony; Garman, Andrea; Clarke, Charles; Sen, Suvadeep

doi:10.1016/s0140-6736(88)92959-5

Cited by 12 publications

(3 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the one prospective study evaluating patients with new-onset seizures, only 4% of patients had relevant laboratory findings of hyperglycemia and hyponatremia . In outpatient clinic–based studies, laboratory findings were of limited utility and no significant results were seen …”

Section: Resultsmentioning

confidence: 99%

New-Onset Seizure in Adults and Adolescents

Gavvala

Schuele

2016

JAMA

113

102

View full text Add to dashboard Cite

nance imaging (MRI) of the brain, 5,6 emphasizing the importance of access to and quality of additional testing. This review will focus on the evaluation of new-onset seizure in adults and adolescents, which includes history and physical examination, the differential diagnosis, characteristic features of each etiology, and features of a rational diagnostic workup. The choice of treatment includes discussion of the consideration of efficacy, adverse effects, dosing, and patient counseling. MethodsThe literature published through November 2016 was reviewed by searching PubMed. The following keywords were used: epilepsy, first time seizure, unprovoked seizures, first time unprovoked seizure, acute symptomaticseizure,antiepileptictreatment,seizureepidemiology,epilepsy epidemiology, women with epilepsy, epilepsy in the elderly, sudden unexplained death in epilepsy, and refractory epilepsy. No language restriction was applied. Review articles, primary literature, and meta-analysis were included in this review. Articles were reviewed if they were published between 1976 and 2016. Articles were rated using IMPORTANCE Approximately 8% to 10% of the population will experience a seizure during their lifetime. Only about 2% to 3% of patients go on to develop epilepsy. Understanding the underlying etiology leading to an accurate diagnosis is necessary to ensure appropriate treatment and that patients with low risk for recurrence are not treated unnecessarily.OBSERVATIONS Patients can present with new-onset seizure for a variety of reasons such as acute symptomatic seizures due to acute brain injury or metabolic derangements, or unprovoked seizures that are the initial manifestation of epilepsy. A patient history and physical examination may identify features more consistent with an epileptic event and laboratory studies and brain imaging can identify an acute insult contributing to the presentation. Patients diagnosed with first-time unprovoked seizure require electroencephalography and epilepsy protocol-specific magnetic resonance imaging of the brain, which includes thin-cut coronal slices to determine risk of recurrence and the need for long-term treatment. In patients who meet the criteria for diagnosis of epilepsy, a carefully selected antiepileptic medication with consideration of comorbidities, adverse effect profile, and type of epilepsy is essential along with appropriate counseling.CONCLUSIONS AND RELEVANCE Approximately 3% of the population will develop epilepsy but 2 to 3 times as many patients will experience a single seizure or seizure-like event. A diagnosis of epilepsy has significant medical, social, and emotional consequences. A careful patient history and physical examination, electroencephalography, and brain imaging are necessary to separate patients with acute symptomatic seizures, single unprovoked seizures, and nonepileptic events from those with new-onset epilepsy.

show abstract

Section: Resultsmentioning

confidence: 99%

New-Onset Seizure in Adults and Adolescents

Gavvala

Schuele

2016

JAMA

113

102

View full text Add to dashboard Cite

show abstract

“…Most recurrences can be expected in the first two years. [66,67]. Patients must be made aware that treatment decreases the risk of epileptic seizure recurrence but does not change the long-term prognosis of epilepsy [68].…”

Section: Deciding To Treatmentioning

confidence: 99%

“…The risk of recurrence following a FUES is highly time dependent, rapidly falling with increasing duration of epileptic seizure freedom. Most recurrences can be expected in the first two years [66, 67]…”

Section: An Unprovoked Epileptic Seizure Has Been Accepted As the Mos...mentioning

confidence: 99%

Management of a first unprovoked epileptic seizure in adolescence and adulthood

Franco

Parreira²,

Bentes

et al. 2021

Epileptic Disorders

View full text Add to dashboard Cite

An epileptic seizure is one of the causes of so-called "transient neurological events" (TNEs). The differential diagnosis of a TNE relies mainly on history and physical examination. Laboratory markers are less frequently useful. After diagnosing an epileptic seizure, a distinction must be made between an acute symptomatic and an unprovoked seizure, since they have different treatments and prognosis. History, physical examination and other examinations (laboratory and imaging) are paramount in this distinction. After the diagnosis of a first unprovoked seizure, an EEG should be requested which may aid in establishing the diagnosis, evaluating the recurrence risk or ascertaining the self-limited nature of the seizure. 3T-MRI with an epilepsy protocol can be considered when CT has not clarified the aetiology. The decision to treat should be discussed with the patient/relatives, taking into account the risk of recurrence, the clinical characteristics (aetiology, seizure type, age, job, epileptic seizure schedule, comorbidities and polymedication), probability of AED side effects, and stigmatization. Nowadays, the chosen regimen is usually monotherapy with a second-generation AED that better suits the patient's characteristics, comorbidities and concurrent medication. Counselling should include first aid, precipitating factors, sport and physical exercise in order to avoid possible driving restrictions, the need for therapy compliance, and risk of recurrence and SUDEP.

show abstract