The Single Seizure-Its Study and Management

Thomas, Madison H.

doi:10.1001/jama.1959.03000220037008

Cited by 28 publications

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“…In accordance with Elwes (28), 68% of our patients with a first seizure during the study period experienced seizure recurrence necessitating anti-epileptic treatment. Of the 41 patients we discharged after a single seizure, 25 Yo had recurrent seizures, this corresponds with other studies (23)(24)(25)(26)(27).…”

Section: Discussionsupporting

confidence: 88%

“…Seizure recurrence after a first unprovoked seizure varied between 27 '70 and 39 070 in previous studies (23)(24)(25)(26)(27) while Elwes (28) found seizure recurrence in 71% after 4 years. The differences being mainly due to the exclusion of subjects who had more than one seizure within a short period (23)(24)(25)(26)(27). In accordance with Elwes (28), 68% of our patients with a first seizure during the study period experienced seizure recurrence necessitating anti-epileptic treatment.…”

Section: Discussionmentioning

confidence: 88%

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Epilepsy in the elderly: prognosis

Lühdorf

Jensen

Plesner

2009

Acta Neurologica Scandinavica

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251 patients were admitted with seizures after the age of 60 years to the county hospital of Frederiksberg during the period 1979–1983, 163 had not received anti‐epileptic treatment prior to admission, of these 151 had been admitted with their first seizure, 88 had established epilepsy at the time of admission. Of patients not previously treated and observed for at least 12 months, 62% remained seizure‐free throughout the study, while 47% with established epilepsy were seizure‐free. Of those not previously treated, 72% entered remission within the first year with a slight increase during the subsequent years. The first year was crucial in determining the long‐term prognosis. Compared to previous studies on the prognosis of epilepsy it seems that prognosis in the elderly is as good or even better. Measurement of S‐drug‐levels at the time of seizure recurrence suggests that suboptimal treatment and poor compliance are important factors, thus indicating the need for regular control and monitoring of S‐drug‐levels. The presence of paroxysmal activity in the EEG was significantly correlated to seizure recurrence. Thirty‐three patients entered nursing homes during the study period. Deterioration in residence status was correlated to degree of dementia and to the presence of focal neurological signs but not to age or to the severity of epilepsy.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 88%

Epilepsy in the elderly: prognosis

Lühdorf

Jensen

Plesner

2009

Acta Neurologica Scandinavica

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“…The seizure was labelled "isolated" if the patient had not experienced a second attack by the time of first attendance at a neurology clinic, some 6 weeks after the event. Two earlier studies (Thomas, 1959;Saunders and Marshall, 1975) with similar results were based on patients attending electroencephalographic departments, in which there would undoubtedly have been a delay between the seizure and the EEG re- Thomas, 1959Johnson et al, 1972Saunders and Marshall, 1975Blom et al, 1978 (13) 13 (10) 13 (10) 15 Data from Elwes et al. 1985, with permission. cording, thus selecting out patients who rapidly developed a second seizure or more seizures.…”

Section: Factors Influencing Prognosismentioning

confidence: 84%

“…Studies of prognosis have been contradictory, however (Table 2). Some investigators have reported a low recurrence rate between 27 and 39% (Thomas, 1959;Saunders and Marshall, 1975;Cleland et al, 1981;Hauser et al, 1982). Others have reported a higher recurrence rate of 64% (Johnson et al, 1972) and 56% (Blom et al, 1978).…”

Section: Factors Influencing Prognosismentioning

confidence: 99%

Early Treatment and Prognosis of Epilepsy

Reynolds

1987

Epilepsia

145

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Recent community-and hospital-based studies of epilepsy from its onset suggest a much better prognosis than previously recognized, with about three-quarters of patients entering long-term remission on current medication. The first two years of medication are crucial in determining longer-term prognosis. Early effective therapy may be important in preventing the evolution of chronic epilepsy. Adverse prognostic factors include brain lesions, neuropsychiatric handicaps, and poor compliance. PROGNOSIS OF EPILEPSYThe traditional and rather gloomy view of prognosis was summarized in the detailed review by Rodin [1] which spans the period from Gowers [2], who first applied a statistical approach to prognosis in the late nineteenth century, to Rodin's own valuable studies. Rodin concluded that only approximately one-third of epileptic patients are likely to achieve a terminal remission of at least two years; that the longer patients are followed up, the more likely is relapse to occur; and that 80 percent of all patients with epilepsy are likely to have a chronic seizure disorder. Although the latter does not rule out short-term remissions, it emphasizes that epilepsy should be regarded as a chronic condition with remissions and exacerbations. Rodin recognized that his review was based almost wholly on studies of chronic patients in institutions or attending special outpatient clinics. He noted that the longer the history of epilepsy prior to hospital consultation the worse the prognosis, and he rightly drew attention to the good prognosis reported by Gowers [2] in patients with a short history of epilepsy treated with bromides. At the time of his review there had been no systematic study of epilepsy at its onset and, as Shorvon [3] has pointed out, a weakness or source of misunderstanding in the studies reviewed was a failure to appreciate certain temporal aspects of the development of epilepsy, arising from the retrospective, cross-sectional nature of the investigations, based on heterogeneous populations of patients with a very variable duration of illness. Another interesting feature of the period, approximately a century, reviewed by Rodin was the introduction and use of many major anticonvulsant drugs of undoubted efficacy, from bromides, through barbiturates, to hydantoins, succinamides, and carbamazepine, most of which are still widely prescribed today. Rodin questioned whether there had been any improvement in overall prognosis throughout this time. A factor which was and still is missing in our understanding of prognosis is any information about the prognosis of untreated epilepsy. Practice was and still is perhaps influenced by Gowers's [2] view that the spontaneous cessation of the disease was an event too rare to be reasonably anticipated in any given case.In the last decade new studies have focused attention on epilepsy as viewed and 79

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“…the findings of earlier recurrence studies which indicated that a considerable proportion of patients with a single seizure had no further attacks. Reported estimates of the risk of a second attack have varied from 27% to 80% (Thomas, 1959;Costeff, 1965;Saunders and Marshall, 1975;Annegers et al, 1978;Blom et al, 1978;Cleland et al, 1981;Hauser et al, 1982;Goodridge and Shorvon, 1983;Elwes et al, 1985;Hopkins et al, 1988;Hart et al, 1990). Most hospital-based estimates have fallen in the lower end of this range whereas estimates in population-based studies and studies in which patients were enrolled within 24 h of an attack lie at the higher end of the range.…”

Section: The Problem Of Diagnosismentioning

confidence: 99%

Some Aspects of Prognosis in the Epilepsies: A Review

1993

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The traditional view that epilepsy is usually a chronic condition in which the prognosis is consistently poor has been challenged in the last 2 decades. Evidence from population-based studies and from intervention studies in newly diagnosed patients has produced a wealth of information of a much better prognosis. It is now generally accepted that as many as 70-80% of people developing seizures for the first time will eventually achieve terminal remission, whereas the remaining 20-30% will continue to have recurrent seizures despite all treatment. Despite the high recurrence rate after a first epileptic seizure, remission usually occurs early and for most persons, epilepsy is a short-lived condition. The exact role of antiepileptic drugs (AEDs) in this good outcome, however, remains open to debate, because the natural history of the untreated condition is largely unknown. In this article, factors that may influence the prognosis of the epilepsies, including the problems of diagnosis, are reviewed. Special emphasis is given to the issue of spontaneous remission and the question of prognosis of different epileptic syndromes.

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The Single Seizure-Its Study and Management

Cited by 28 publications

References 0 publications

Epilepsy in the elderly: prognosis

Epilepsy in the elderly: prognosis

Early Treatment and Prognosis of Epilepsy

Some Aspects of Prognosis in the Epilepsies: A Review

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