Neurology, Alfred Health, Melbourne, Victoria, Australia
Central Clinical School, Monash University, Melbourne, Victoria, Australia.
J Neurol Neurosurg Psychiatry. 2019 Sep;90(9):1039-1045. doi: 10.1136/jnnp-2018-320215. Epub 2019 Apr 4.
Almost 10% of people will experience at least one seizure over a lifetime. Although common, first seizures are serious events and warrant careful assessment and management. First seizures may be provoked by acute or remote symptomatic factors including life-threatening metabolic derangements, drug toxicity or structural brain lesions. An unprovoked first seizure may herald the onset of epilepsy and may be accompanied by medical and psychiatric illnesses. Accidents, injuries and death associated with first seizures are likely under-reported. The cognitive and emotional impact of first seizures is often neglected. Evaluation of a patient presenting with a first seizure requires careful history-taking and early specialist assessment, however optimal management strategies have not been extensively investigated. Further, advances in technology and the role of eHealth interventions such as telemedicine may be of value in the care of patients who have experienced a first seizure. This article reviews the impact and implications of first seizures beyond the scope provided in current guidelines which tend to focus on assessment and management. It examines the effect of first seizures on the well-being of patients; assesses morbidity and premature mortality in first seizures and discusses current and future directions to optimise safety and health of people with first seizures, with a focus on adult patients. Recognition of these issues is essential to provide adequate care for people with first seizures.
一生中，几乎有 10%的人会经历至少一次癫痫发作。尽管癫痫发作很常见，但首次癫痫发作是严重的事件，需要仔细评估和管理。首次癫痫发作可能由急性或远期症状性因素引起，包括危及生命的代谢紊乱、药物毒性或结构性脑损伤。无诱因的首次癫痫发作可能预示着癫痫的发作，并可能伴有医疗和精神疾病。与首次癫痫发作相关的事故、伤害和死亡可能报告不足。首次癫痫发作的认知和情感影响往往被忽视。对出现首次癫痫发作的患者的评估需要仔细的病史采集和早期专家评估，但尚未广泛研究最佳管理策略。此外，技术进步和远程医疗等电子健康干预措施的作用可能对首次癫痫发作患者的护理有价值。本文综述了首次癫痫发作对指南范围以外的影响和意义，这些指南往往侧重于评估和管理。本文还探讨了首次癫痫发作对患者健康的影响；评估了首次癫痫发作的发病率和过早死亡率，并讨论了当前和未来的方向，以优化首次癫痫发作患者的安全性和健康，重点是成年患者。认识到这些问题对于为首次癫痫发作患者提供充分的护理至关重要。
