First seizure presentation: Do multiple seizures within 24 hours predict recurrence?

Abstract

We compared clinical features and prognosis of 72 adults with a first-ever seizure presentation comprising multiple discrete seizures within 24 hours to 425 patients presenting with a single seizure. Those presenting with multiple seizures were no more likely to have seizure recurrence, irrespective of etiology or treatment. Hence, a presentation with multiple seizures within 24 hours should be regarded as a single event, in keeping with the International League Against Epilepsy recommendations.

Evidence-Based Guideline: Management of an Unprovoked First Seizure in Adults: Report of the Guideline Development Subcommittee of the American Academy of Neurology and the American Epilepsy Society

“…16,17 Of 2 Class I 11,13 and 2 Class II studies, 19,20 most confirm that individuals with a seizure related to a prior brain lesion 11,13,19,20 (including those due to stroke, trauma, CNS infection, cerebral palsy, and cognitive developmental disability), a so-called "remote symptomatic" seizure, 5,11,23,24 demonstrate an approximately 2-fold higher risk for seizure recurrence. That increased risk is illustrated in a representative study with seizure recurrence rates of 26%, 41%, and 48% at 1, 3, and 5 years, respectively, as compared with 10%, 24%, and 29% at these same intervals for patients with a seizure of unknown cause.…”

Neuroimaging of first-ever seizure

“…6 All patients underwent a standardized clinical assessment and the clinical, imaging, and EEG findings were prospectively entered into a database. The patients were drawn from a referral population of approximately 1.2 million people, mainly from metropolitan Perth, with most referred from emergency departments and the remainder from in-hospital referrals and general practitioners.…”

Evidence-based guideline: Management of an unprovoked first seizure in adults

“…Tables e-1 Evidence. We identified 2 prognostic Class I [10][11][12][13][14] and 8 prognostic Class II studies [15][16][17][18][19][20][21][22] addressing the probability that an adult with an unprovoked first seizure would have recurrent seizures, and estimated the recurrence risk from these pooled data, which included studies wherein AED treatment was not randomized or controlled (table 1, figure 1). Generalized tonic-clonic convulsive seizures comprise the major seizure type, with some studies including only patients with such seizures.…”

“…11,12,15,16 Also, seizure recurrence was lower for patients treated with AEDs in most of these studies, but treatment often was not randomized. 10,11,16,17,19,20 These 2 factors would lead to variability and underestimation of recurrence risk. We also identified clinical variables found in studies to be associated with an increased risk of seizure recurrence.…”

“…The most consistently noted factors associated with an increased risk of seizure recurrence following an unprovoked first seizure include a prior brain lesion or insult causing the seizure, 3,11,13,19,23,24 an EEG with epileptiform abnormalities (characterized by spikes or sharp waves), 3,[11][12][13][16][17][18][19]23,24 a significant brain-imaging abnormality (judged the cause of the seizure), 3,6,9,20,24 and a nocturnal seizure. 16,17 Of 2 Class I 11,13 and 2 Class II studies, 19,20 most confirm that individuals with a seizure related to a prior brain lesion 11,13,19,20 (including those due to stroke, trauma, CNS infection, cerebral palsy, and cognitive developmental disability), a so-called "remote symptomatic" seizure, 5,11,23,24 demonstrate an approximately 2-foldhigher risk of seizure recurrence. That increased risk is illustrated in a representative study with seizure recurrence rates of 26%, 41%, and 48% at 1, 3, and 5 years, respectively, as compared with 10%, 24%, and 29% at these same intervals for patients with a seizure of unknown cause.…”