Risk of recurrence after first unprovoked tonic-clonic seizure in adults

Abstract

The likelihood of seizure recurrence after a first unprovoked seizure has profound social, vocational and emotional implications for the patients. Recurrence rates have varied between 27% and 71% in various studies, and the management of patients with a single unprovoked seizure is a controversial topic. In this prospective study we investigated the influence of age, sex, family history, EEG patterns, and anticonvulsant drug (ACD) therapy on seizure recurrence after a first unprovoked tonic-clonic seizure in adults. For this purpose, between October 1988 and January 1991, we studied adult patients who had experienced their after unprovoked tonic-clonic seizure within last 2 months before neurological consultation, and followed them until June 1993. There were 147 patients who met the criteria for inclusion. Overall cumulative recurrence rates were 31.8% by 6 months, 41.3% by 1 year, 44.1% by 2 years, 42.2% by 3 years, and 45.2% by 4 years. Among the risk factors that were evaluated, the time of the day at which the initial seizure occurred was associated significantly (P < 0.05) with seizure recurrence. In our series, 62 patients received ACD and 85 did not. We did not find a significant difference in recurrence rate with regard to ACD therapy. Our results are comparable with those of studies reported previously and suggest that the majority of recurrences after a first unprovoked seizure were seen in the first year (in our series 89% of all recurrences). In our study there was no significant predictor of seizure recurrence, except the time of day at which the initial seizure occurred.

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.…”

Neurologic Conditions: Assessing Medical Fitness to Drive

“…[81][82][83][84] Some of the discrepancy in patients with first unprovoked seizure is due to study methods and types of prognostic factors included in these studies.…”

Clinical profile of Solitary Seizures

“…Views differ regarding their treatment, investigations and factors related to the recurrence of seizure. In order to study the factors related to seizure recurrence, cases of seizure who behaved like 'solitary seizure' at least in the initial first year but had recurrence later, were taken to be cases of solitary seizure, since the chances of seizure recurrence is maximum in the first year [1,3].…”

“…Some workers have noted increased seizure recurrence with abnormal EEG [5,8,9], others have noted increased seizure recurrence with normal EEG [1]. Edmondstone found EEG to be of uncertain value [10].…”

“…The likelihood of seizure recurrence after a first unprovoked seizure has profound social, vocational and emotional implications for the patients [1]. There is wide individual variation in the management of these cases ranging from mere observation to detailed investigations and full treatment for long duration.…”