Unprovoked Epileptic Seizures Research Articles

Prevalence of childhood epilepsy in Kaunas, Lithuania

The prevalence of epilepsy in children aged 0–15 years of Kaunas city, Lithuania, was evaluated on 1 January 1995. Multiple sources for case identification were used, i.e. medical records at the university hospital, regional outpatient clinics and consultation centres, institutions, schools and kindergartens for the handicapped. Active epilepsy was defined as two or more unprovoked epileptic seizures with at least one seizure occurring within the previous 5 years, regardless of the antiepileptic drug treatment. Prevalence was found to be 4.25 (3.42, if age-standardized) in 1000. The highest rate was found in the 10–14 years age group. The male/female ratio was 1.29. No possible causes could be determined in 60.3% of cases. Congenital causes were diagnosed in 18.8% of cases, perinatal causes in 15.3%, traumatic causes in 2.6% and neuroinfectious causes in 2.4%. Classification of epilepsies and epileptic syndromes [Commission on Classification and Prognosis of the International League Against Epilepsy. Proposal for revised classification of epilepsies and epileptic syndromes. Epilepsia 1989; 30: 389–399] revealed that 50% of cases were localization-related epilepsies, 29.9% were generalized epilepsies, 15.9% were undetermined whether partial or generalized and 4.2% were unclassifiable. Rates for idiopathic, symptomatic and cryptogenic cases are presented.

The Single Seizure

A number of studies have investigated the outlook for patients who present soon after a first-ever single, unprovoked epileptic seizure. Such seizures are usually of a bilateral tonic-clonic nature. It has been demonstrated that further attacks occur in 40 to 50% of individuals who are not subsequently treated with anticonvulsants, most of the recurrences occurring within 6 months of the initial seizure. The risk of recurrence is higher if the initial seizure is a partial one, if abnormal neurological findings are present, or if the EEG is abnormal. Two studies have now shown that the risk of seizure recurrence is more than halved if anticonvulsants are prescribed from the time of presentation after the initial seizure. Therefore, it appears that there is a case for commencing anticonvulsant therapy if a patient is seen in the first few months after a single unprovoked seizure which is of a partial type, or if abnormalities are present on neurological examination, or if the EEG shows paroxysmal activity. Anticonvulsants appropriate for the patient's seizure type should be used.

Overview of Seizures

Epilepsy is a chronic disorder characterized by recurrent unprovoked epileptic seizures. Not all epileptic seizures indicate the existence of an epileptic disorder; many represent a natural response of the normal brain to transient noxious insults that are not likely to be repeated (reactive seizures). Not only is it important to distinguish conditions associated with these relatively benign epileptic events from epilepsy, but also it is important to recognize the many types of epileptic seizures and many types of epilepsy, reflecting different underlying anatomic and pathophysiologic substrates, which determine therapy and prognosis. Acute care for an epileptic seizure, therefore, includes search for an underlying treatable cause and protection against recurrence, if necessary. Neurologic consultation in the emergency department can help avoid unnecessary diagnostic procedures and treatments, particularly in patients with reactive seizures and established epileptic disorders. Communication with the patient's continuing care physician is an essential part of the emergency department management plan.

An incident case-referent study of epileptic seizures children: Genetic and socioeconomic factors

In a prospective incident community-based case-referent study, 51 children with onset of unprovoked epileptic seizures after the neonatal period were compared with 89 age- and sex-matched referents with regard to genetic and socioeconomic factors. Epilepsy was more common in first-degree relatives of cases [odds ratio (OR) = 11.6; 95% confidence interval (CI) = 2.2; 61.1]. The proportion of cases with a positive family history of epilepsy was also higher in cases than referents (OR = 12.6, CI = 2.3, 69.7 with epilepsy in first-degree relatives and OR = 10.4, CI = 3.8, 28.7 with epilepsy in any type of relative). The proportion of cases with febrile convulsions in relatives was higher than in referents (OR = 4.3, CI = 1.6, 11.7). More cases than referents (OR = 12.4, CI = 2.2, 70.1) had had a head trauma of moderate degree 6 months preceding onset of seizures. Regarding family characteristics, the risk was decreased by level of education for both father and mother (test for trend, p = 0.04). The risk for seizures was increased by number of siblings (test for trend p = 0.004). Finally, there was a tendency to increased risk with increased age of father and mother at birth of case/referents (test for trend p = 0.09 and 0.30, respectively).

Newly diagnosed unprovoked epileptic seizures in adults, a prospective incidence study: L. Forsgren, G. Bucht, and S. Eriksson (Departments of Neurology and Geriatrics, Umeå University Hospital, Umeå)

Newly diagnosed unprovoked epileptic seizures in adults, a prospective incidence study: L. Forsgren, G. Bucht, and S. Eriksson (Departments of Neurology and Geriatrics, Umeå University Hospital, Umeå)

Randomized clinical trial on the efficacy of antiepileptic drugs in reducing the risk of relapse after a first unprovoked tonic‐clonic seizure

We conducted a randomized multicenter clinical trial on 397 patients ranging in age from 2 to 70 years to assess the effectiveness of treatment of the first unprovoked epileptic seizure. Subjects seen within 7 days after a first witnessed tonic-clonic seizure with or without partial onset were randomized to immediate treatment (carbamazepine, phenytoin, phenobarbital, or sodium valproate) or to treatment with the same drugs only after seizure recurrence. We excluded individuals with acute symptomatic seizures, progressive neurologic disorders, or gross psychiatric illness. Thirty-six of 204 subjects randomized to treatment and 75 of 193 randomized to delayed treatment experienced seizure recurrence during follow-up. The cumulative time-dependent risk of relapse among treated subjects was 25% by 24 months. The corresponding figure for untreated subjects was 51%. The risk of relapse was 2.8 times higher (95% CI, 1.9 to 4.2) for untreated subjects. There were no interactions between age and EEG findings (the only predictors of risk of relapse) and treatment effects. We conclude that treatment of the first seizure with antiepileptic drugs leads to a significant reduction of the risk of relapse.