Hesdorffer Dale C, Benn Emma K T, Cascino Gregory D, Hauser W Allen
Department of Epidemiology, The Gertrude H. Sergievsky Center, Mailman School of Public Health at Columbia University, New York, New York 10032, USA.
Epilepsia. 2009 May;50(5):1102-8. doi: 10.1111/j.1528-1167.2008.01945.x. Epub 2009 Jan 26.
To compare mortality and subsequent unprovoked seizure risk in a population-based study of acute symptomatic seizure and first unprovoked seizure due to static brain lesions.
We ascertained all first episodes of acute symptomatic seizure and unprovoked seizure due to central nervous system (CNS) infection, stroke, and traumatic brain injury (TBI). Subjects were residents of Rochester, Minnesota, identified through the Rochester Epidemiology Project's records-linkage system between 1/1/55 and 12/31/84. Information was collected on age, gender, seizure type, etiology, status epilepticus (SE), 30-day and 10-year mortality, and subsequent episodes of unprovoked seizure.
Two hundred sixty-two individuals experienced a first acute symptomatic seizure and 148 individuals experienced a first unprovoked seizure, all due to static brain lesions. Individuals with a first acute symptomatic seizure were 8.9 times more likely to die within 30 days compared to those with a first unprovoked seizure [95% confidence intervals (CI) = 3.5-22.5] after adjustment for age, gender, and SE. Among 30-day survivors, the risk of 10-year mortality did not differ. Over the 10-year period, individuals with a first acute symptomatic seizure were 80% less likely to experience a subsequent unprovoked seizure compared with individuals with a first unprovoked seizure [adjusted rate ratio (RR) = 0.2, 95% CI = 0.2-0.4].
The prognosis of first acute symptomatic seizures differs from that of first unprovoked seizure when the etiology is stroke, TBI, and CNS infection. Acute symptomatic seizures have a higher early mortality and a lower risk for subsequent unprovoked seizure. These differences argue against the inclusion of acute symptomatic seizures as epilepsy.
在一项基于人群的急性症状性癫痫发作及因静止性脑损伤所致首次特发性癫痫发作的研究中，比较死亡率及后续特发性癫痫发作风险。
我们确定了所有因中枢神经系统（CNS）感染、中风和创伤性脑损伤（TBI）引起的急性症状性癫痫发作和特发性癫痫发作的首次发作情况。研究对象为明尼苏达州罗切斯特市的居民，通过罗切斯特流行病学项目的记录链接系统在1955年1月1日至1984年12月31日期间确定。收集了年龄、性别、癫痫发作类型、病因、癫痫持续状态（SE）、30天和10年死亡率以及后续特发性癫痫发作情况等信息。
262人经历了首次急性症状性癫痫发作，148人经历了首次特发性癫痫发作，均由静止性脑损伤引起。在对年龄、性别和SE进行调整后，首次急性症状性癫痫发作的个体在30天内死亡的可能性是首次特发性癫痫发作个体的8.9倍[95%置信区间（CI）= 3.5 - 22.5]。在30天幸存者中，10年死亡率无差异。在10年期间，首次急性症状性癫痫发作的个体与首次特发性癫痫发作的个体相比，后续发生特发性癫痫发作的可能性低80%[调整后率比（RR）= 0.2，95% CI = 0.2 - 0.4]。
当中风、TBI和CNS感染为病因时，首次急性症状性癫痫发作的预后与首次特发性癫痫发作不同。急性症状性癫痫发作早期死亡率较高，后续特发性癫痫发作风险较低。这些差异反对将急性症状性癫痫发作纳入癫痫范畴。
