Short-term risk of recurrence after a first unprovoked seizure

Abstract

Introduction The rate and predictive factors of short-term recurrences are not known. There are a lot of literatures illustrating the risk of recurrence especially in mid-long-term risk. SFN suggests a consultation with a neurologist at the delay of one month to avoid misdiagnosis. Objectives First objective: to evaluate the risk of recurrence after a first unprovoked seizure at one month. Secondary objective: The associative risk factors of recurrence at 1 month and the recurrence risk at 3 months. Methods This is a prospective observational study based on a consecutive series of 140 adult patients admitted in ED for a first unprovoked seizure during one year. All the included patients were followed in a specialized consultation at 1 month. The collected data was exhaustive including: demographic criteria, clinical examination, recurrence at 1 and 3 months, EEG , imaging, precipitating factors , type of seizure and prescribed treatment. Resultats Among the 140 patients diagnosed as first unprovoked seizure by the ED, only 80 patients have their diagnosis confirmed by the specialist at the consultation performed at 1 month. Nine patients had recurrence before the specialized consultation at one month (11%). We were able to define specific valid risk factors of short-term recurrence (less than 1 month): focal seizure ( P = 0.015), abnormal EEG in the first 48 hours as focal slowness (P = 0. 058) and imaging abnormalities (P = 0.19). Discussion Our study is the first project addressing the question of the short term recurrence risk of seizure after a first unprovoked event. Our results for the risk of recurrence at 3 months are compatible with most of literature. This emphasizes the importance of a specialized consultation to verify the appropriate diagnosis. The ED should be devoted only in the differential diagnosis workup. Conclusion The risk of early recurrence at one month after an unprovoked seizure is estimated at 11%. Most of the patients came in the ED does not had any recurrence seizure in the first month. The risk factors are: EEG, type of seizure and imaging. The delay of 1 month is safe.