Bergey Gregory K
Continuum (Minneap Minn). 2016 Feb;22(1 Epilepsy):38-50. doi: 10.1212/CON.0000000000000271.
Assessment of the patient with a first seizure is a common and important neurologic issue. Less than 50% of patients who have a first unprovoked seizure have a second seizure; thus, the evaluation should focus on determining the patient's risk of seizure recurrence.
A number of population studies, including some classic reports, have identified the relative risk factors for subsequent seizure recurrence. The 2014 update of the International League Against Epilepsy definition of epilepsy incorporates these findings, and in 2015, the American Academy of Neurology published a guideline that analyzed the available data.
Provoked or acute symptomatic seizures do not confer increased risk for subsequent unprovoked seizure recurrence. Multiple seizures in a given 24-hour period do not increase the risk of seizure recurrence. Remote symptomatic seizures, an epileptiform EEG, a significant brain imaging abnormality, and nocturnal seizures are risk factors for seizure recurrence. Antiepileptic drug therapy delays the time to second seizure but may not influence long-term remission.
对首次发作的患者进行评估是常见且重要的神经学问题。首次无诱因发作的患者中，不到50%会出现第二次发作；因此，评估应着重于确定患者癫痫复发的风险。
包括一些经典报告在内的多项人群研究已经确定了后续癫痫复发的相对风险因素。国际抗癫痫联盟2014年对癫痫定义的更新纳入了这些发现，并且在2015年，美国神经病学学会发布了一项分析现有数据的指南。
诱发性或急性症状性发作不会增加后续无诱因癫痫复发的风险。在给定的24小时内多次发作不会增加癫痫复发的风险。既往有症状性发作、脑电图呈癫痫样放电、显著的脑影像学异常以及夜间发作都是癫痫复发的风险因素。抗癫痫药物治疗会延迟第二次发作的时间，但可能不会影响长期缓解情况。
