Effect of the revised definition of epilepsy on treatment decisions and seizure recurrence after a first epileptic seizure.

Autor: Linka L; Epilepsy Center Hessen, University Hospital Marburg, Marburg, Germany.; Center for Mind, Brain and Behavior, CMBB, Philipps-University Marburg, Marburg, Germany., Magnus B; Epilepsy Center Hessen, University Hospital Marburg, Marburg, Germany., Habermehl L; Epilepsy Center Hessen, University Hospital Marburg, Marburg, Germany.; Center for Mind, Brain and Behavior, CMBB, Philipps-University Marburg, Marburg, Germany., Tsalouchidou PE; Epilepsy Center Hessen, University Hospital Marburg, Marburg, Germany.; Center for Mind, Brain and Behavior, CMBB, Philipps-University Marburg, Marburg, Germany., Zahnert F; Epilepsy Center Hessen, University Hospital Marburg, Marburg, Germany.; Center for Mind, Brain and Behavior, CMBB, Philipps-University Marburg, Marburg, Germany., Möeller L; Epilepsy Center Hessen, University Hospital Marburg, Marburg, Germany.; Center for Mind, Brain and Behavior, CMBB, Philipps-University Marburg, Marburg, Germany., Krause K; Epilepsy Center Hessen, University Hospital Marburg, Marburg, Germany.; Center for Mind, Brain and Behavior, CMBB, Philipps-University Marburg, Marburg, Germany., Knake S; Epilepsy Center Hessen, University Hospital Marburg, Marburg, Germany.; Center for Mind, Brain and Behavior, CMBB, Philipps-University Marburg, Marburg, Germany., Menzler K; Epilepsy Center Hessen, University Hospital Marburg, Marburg, Germany.; Center for Mind, Brain and Behavior, CMBB, Philipps-University Marburg, Marburg, Germany.
Jazyk: angličtina
Zdroj: European journal of neurology [Eur J Neurol] 2023 Jun; Vol. 30 (6), pp. 1557-1564. Date of Electronic Publication: 2023 Mar 26.
DOI: 10.1111/ene.15769
Abstrakt: Background: Studies on risk factors for epilepsy and seizure recurrence after a first seizure are usually based on the old definition of epilepsy with the need for two unprovoked seizures. The current definition of epilepsy allows diagnosis and treatment of epilepsy after a first seizure if the recurrence risk is >60%. We evaluate treatment decisions, seizure recurrence and risk factors for epilepsy related to the application of the new definition of epilepsy.
Methods: Data of 629 patients with a first seizure were analyzed to investigate changes of treatment decisions and seizure recurrence after the revised definition of epilepsy. We used binary logistic regression to investigate the impact of multiple factors influencing seizure recurrence like electroencephalogram (EEG) and magnetic resonance imaging (MRI) results and administration of antiseizure medication (ASM).
Results: The proportion of patients receiving ASM significantly increased from 70.4% to 80.5% (p = 0.015) following the new epilepsy definition, without any significant changes in the recurrence rate (40.8% vs. 45.5% after 2 years, p > 0.05). The presence of interictal epileptiform discharges (IED) in the EEG increased (OR = 1.98) and administration of ASM decreased (OR = 0.43) recurrence rates significantly.
Conclusions: The new definition of epilepsy was associated with increased application of ASM, but not with reduced recurrence rates. The study confirms the presence of IED as a strong risk factor for seizure recurrence and the protective effect of ASM. The influence of imaging findings, which have a strong impact on the new definition of epilepsy, could not be confirmed.
(© 2023 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.)
Databáze: MEDLINE
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