Seizure Recurrence after a First Unprovoked Seizure

Abstract

We studied 244 patients (of all ages) who presented with a first unprovoked seizure and were followed for a median of 22 months in order to ascertain the risk of subsequent seizures. The cumulative risks of recurrence were 16 per cent at 12 months, 21 per cent at 24 months, and 27 per cent at 36 months after the initial seizure. The risk of recurrence in patients with a history of prior neurologic insult was 34 per cent; all recurrences in this group were observed within the first 20 months. Only 17 per cent of patients without such a history (classified as idiopathic) had a recurrence by 20 months; recurrence in this group was 26 per cent by 36 months. Patients with no recurrence for 36 months did not have a recurrence after that time. Among idiopathic cases the risk of recurrence was increased in patients with generalized spike-wave electroencephalograms (50 per cent at 18 months) and in those who had a sibling with seizures (35 per cent at four months). Age at first seizure, sex, seizure type, onset with status epilepticus, or abnormality on neurologic examination did not affect the risk of recurrence.

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.…”

“…81 The greatest risk of recurrence is in patients with previous neurologic injuries. Other Factors that decrease the probability of a seizure-related motor vehicle collision include a long seizure-free interval, reliable aura, a good driving record prior to seizure and physician directed reduction in the numbers of AEDs.…”

Clinical profile of Solitary Seizures

“…There is no convincing data demonstrating that early treatment has any favourable effect on the recurrence rate [4,6]. However, Elwes and Reynolds recommend immediate treatment after a first seizure as it might reduce the recurrence rate and improve subsequent prognosis [7,8].…”

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.…”