Risk of Recurrence After an Initial Unprovoked Seizure

Abstract

A cohort of 424 patients was followed to determine the patterns of risk for recurrence after an initial unprovoked seizure. Overall, the risk of recurrence was 36% by 1 year, 48% by 3 years, and 56% by 5 years. The risk of subsequent seizures was lower for patients with idiopathic seizures than for those whose seizures had a presumed etiology. Among cases for which initial seizure was classified as idiopathic, EEG abnormalities, abnormal neurologic examination findings, and initial partial seizures were identified as significant independent predictors of higher recurrence risks.

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

“…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 two factors would lead to variability and underestimation of recurrence risk.…”

“…We identified 2 prognostic Class I 10-14 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 and figure 1). Generalized tonic-clonic convulsive seizures comprise the major seizure type, with some studies including only patients with such seizures.…”

2015 ACVIM Small Animal Consensus Statement on Seizure Management in Dogs

“…A number of relative risk factors have been identified in epileptic people, including a diagnosis of current or previously defined cerebral lesions or trauma, presence of interictal EEG epileptic discharges (up to 90% recurrence rate) and a history of marked postictal adverse effects 13, 14. Evidence‐based guidelines from several international groups are well established for people based on risk‐benefit ratio and predictability factors of drug effect 15, 16, 17. From these guidelines, several commonalities exist in guiding clinical practice including confirmation of an epileptic seizure event and seizure type, obtaining a definitive diagnosis, knowledge that recurrent seizure activity is correlated with poorer long‐term treatment success, and the influence of treatment on quality‐of‐life (QOL) factors 18.…”

Electroencephalogram and first episode afebrile seizure in children

“…[12][13][14] At any given time, the reported risk of recurrence is highly variable. For example, at 1 year, it ranges from a low of 14% to a high of 65%.…”