Is the first seizure epilepsyand when?
Is the first seizure epilepsyand when?
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DOI：
10.1111/epi.13093
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发表时间：
2015-09-01
期刊：
影响因子：
5.6
通讯作者：
Dunne, John
中科院分区：
文献类型：
--
作者：
Lawn, Nicholas;Chan, Josephine;Dunne, John
ObjectiveEpilepsy has recently been redefined to include a single unprovoked seizure if the probability of recurrence is 60% over the following 10years. This definition is based on the estimated risk of a third seizure after two unprovoked seizures, using the lower-limit 95% confidence interval (CI) at 4years, and does not account for the initially high recurrence rate after first-ever seizure that rapidly falls with increasing duration of seizure freedom. We analyzed long-term outcomes after the first-ever seizure, and the influence of duration of seizure freedom on the likelihood of seizure recurrence, and their relevance to the new definition of epilepsy.MethodsProspective analysis of 798 adults with a first-ever unprovoked seizure seen at a hospital-based first seizure clinic between 2000 and 2011. The likelihood of seizure recurrence was analyzed according to the duration of seizure freedom, etiology, electroencephalography (EEG), and neuroimaging findings.ResultsThe likelihood of seizure recurrence at 10years was 60% in patients with epileptiform abnormalities on EEG or neuroimaging abnormalities, therefore, meeting the new definition of epilepsy. However, the risk of recurrence was highly time dependent; after a brief period (12weeks) of seizure freedom, no patient group continued to fulfill the new definition of epilepsy. Of 407 patients who had a second seizure, the likelihood of a third seizure at 4years was 68% (95% CI 63-73%) and at 10years was 85% (95% CI 79-91%).SignificanceThe duration of seizure freedom following first-ever seizure substantially influences the risk of recurrence, with none of our patients fulfilling the new definition of epilepsy after a short period of seizure freedom. When a threshold was applied based on the 10-year risk of a third seizure from our data, no first-seizure patient group ever had epilepsy. These data may be utilized in a definition of epilepsy after a first-ever seizure.
