Recurrence risk after a first remote symptomatic seizure in adults: Epilepsy or not?

Abstract The ILAE practical definition of epilepsy has a one seizure possibility to diagnose epilepsy after a first seizure if the recurrence risk is very high. The recurrence risk after a first seizure in brain disorders (first remote seizure) is often high, but varies with etiology, so more specif...

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Autor principal:	Johan Zelano
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	diagnosis remote seizure seizure recurrence unprovoked seizure Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/1712658646b64ba7865426d49d1cb0a3
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spelling	oai:doaj.org-article:1712658646b64ba7865426d49d1cb0a32021-12-01T06:09:19ZRecurrence risk after a first remote symptomatic seizure in adults: Epilepsy or not?2470-923910.1002/epi4.12543https://doaj.org/article/1712658646b64ba7865426d49d1cb0a32021-12-01T00:00:00Zhttps://doi.org/10.1002/epi4.12543https://doaj.org/toc/2470-9239Abstract The ILAE practical definition of epilepsy has a one seizure possibility to diagnose epilepsy after a first seizure if the recurrence risk is very high. The recurrence risk after a first seizure in brain disorders (first remote seizure) is often high, but varies with etiology, so more specific information is needed for clinical practice. This review describes etiology‐specific recurrence risks in adults with a first remote seizure in stroke, traumatic brain injury, infections, dementia, multiple sclerosis, and tumors. Most studies are short, single center, and retrospective. Inclusion criteria, outcome ascertainment, and results vary. Few patient categories are clearly above the epilepsy threshold of recurrence risk, and there are surprisingly little data for important etiologies like brain infections. Beside stroke, severe TBI could have a sufficiently high recurrence risk for early epilepsy diagnosis, but more studies are needed, preferably prospective ones. The literature is uninformative regarding which seizures qualify as remote. The clinical implication of the low level of available evidence is that for other etiologies than stroke, seizure recurrence remains the most appropriate indicator of epilepsy for most patients with a first remote seizure. Nonetheless, there are worrying indications of a diagnostic drift, which puts patients with a preexisting brain disorder at risk of misdiagnosis. Although there are drawbacks to an intermediate term like “possible epilepsy,” it could perhaps be useful in cases when the recurrence risk is high, but epilepsy criteria are not definitely met after a first remote seizure.Johan ZelanoWileyarticlediagnosisremote seizureseizure recurrenceunprovoked seizureNeurology. Diseases of the nervous systemRC346-429ENEpilepsia Open, Vol 6, Iss 4, Pp 634-644 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	diagnosis remote seizure seizure recurrence unprovoked seizure Neurology. Diseases of the nervous system RC346-429
spellingShingle	diagnosis remote seizure seizure recurrence unprovoked seizure Neurology. Diseases of the nervous system RC346-429 Johan Zelano Recurrence risk after a first remote symptomatic seizure in adults: Epilepsy or not?
description	Abstract The ILAE practical definition of epilepsy has a one seizure possibility to diagnose epilepsy after a first seizure if the recurrence risk is very high. The recurrence risk after a first seizure in brain disorders (first remote seizure) is often high, but varies with etiology, so more specific information is needed for clinical practice. This review describes etiology‐specific recurrence risks in adults with a first remote seizure in stroke, traumatic brain injury, infections, dementia, multiple sclerosis, and tumors. Most studies are short, single center, and retrospective. Inclusion criteria, outcome ascertainment, and results vary. Few patient categories are clearly above the epilepsy threshold of recurrence risk, and there are surprisingly little data for important etiologies like brain infections. Beside stroke, severe TBI could have a sufficiently high recurrence risk for early epilepsy diagnosis, but more studies are needed, preferably prospective ones. The literature is uninformative regarding which seizures qualify as remote. The clinical implication of the low level of available evidence is that for other etiologies than stroke, seizure recurrence remains the most appropriate indicator of epilepsy for most patients with a first remote seizure. Nonetheless, there are worrying indications of a diagnostic drift, which puts patients with a preexisting brain disorder at risk of misdiagnosis. Although there are drawbacks to an intermediate term like “possible epilepsy,” it could perhaps be useful in cases when the recurrence risk is high, but epilepsy criteria are not definitely met after a first remote seizure.
format	article
author	Johan Zelano
author_facet	Johan Zelano
author_sort	Johan Zelano
title	Recurrence risk after a first remote symptomatic seizure in adults: Epilepsy or not?
title_short	Recurrence risk after a first remote symptomatic seizure in adults: Epilepsy or not?
title_full	Recurrence risk after a first remote symptomatic seizure in adults: Epilepsy or not?
title_fullStr	Recurrence risk after a first remote symptomatic seizure in adults: Epilepsy or not?
title_full_unstemmed	Recurrence risk after a first remote symptomatic seizure in adults: Epilepsy or not?
title_sort	recurrence risk after a first remote symptomatic seizure in adults: epilepsy or not?
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/1712658646b64ba7865426d49d1cb0a3
work_keys_str_mv	AT johanzelano recurrenceriskafterafirstremotesymptomaticseizureinadultsepilepsyornot
_version_	1718405459362185216

Recurrence risk after a first remote symptomatic seizure in adults: Epilepsy or not?

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