Western Australian Adult Epilepsy Service, Perth, Western Australia, Australia.
Discipline of Internal Medicine, Medical School, The University of Western Australia, Perth, Western Australia, Australia.
Epilepsia. 2023 Oct;64(10):2714-2724. doi: 10.1111/epi.17712. Epub 2023 Jul 28.
Patients with a first-ever unprovoked seizure commonly have subsequent seizures and identifying predictors of recurrence has important management implications. Both prior brain insult and epileptiform abnormalities on electroencephalography (EEG) are established predictors of seizure recurrence. Some studies suggest that a first-ever seizure from sleep has a higher likelihood of recurrence. However, with relatively small numbers and inconsistent definitions, more data are required.
Prospective cohort study of adults with first-ever unprovoked seizure seen by a hospital-based first seizure service between 2000 and 2015. Clinical features and outcomes of first-ever seizure from sleep and while awake were compared.
First-ever unprovoked seizure occurred during sleep in 298 of 1312 patients (23%), in whom the 1-year cumulative risk of recurrence was 56.9% (95% confidence interval [CI] 51.3-62.6) compared to 44.2% (95% CI 41.1-47.3, p < .0001) for patients with first-ever seizure while awake. First-ever seizure from sleep was an independent predictor of seizure recurrence, with a hazard ratio [HR] of 1.44 (95% CI 1.23-1.69), similar to epileptiform abnormalities on EEG (HR 1.48, 95% CI 1.24-1.76) and remote symptomatic etiology (HR 1.47, 95% CI 1.27-1.71). HR for recurrence in patients without either epileptiform abnormalities or remote symptomatic etiology was 1.97 (95% CI 1.60-2.44) for a sleep seizure compared to an awake seizure. For first seizure from sleep, 76% of second seizures also arose from sleep (p < .0001), with 65% of third seizures (p < .0001) also from sleep. Seizures from sleep were less likely to be associated with injury other than orolingual trauma, both with the presenting seizure (9.4% vs 30.6%, p < .0001) and first recurrence (7.5% vs 16.3%, p = .001).
First-ever unprovoked seizures from sleep are more likely to recur, independent of other risk factors, with recurrences also usually from sleep, and with a lower risk of seizure-related injury. These findings may inform treatment decisions and counseling after first-ever seizure.
首次无诱因发作的患者常继发癫痫，识别复发的预测因素具有重要的管理意义。既往脑损伤和脑电图（EEG）上的癫痫样异常都是复发的既定预测因素。一些研究表明，睡眠中首次发作更有可能复发。然而，由于数据数量相对较少且定义不一致，需要更多的数据。
对 2000 年至 2015 年间在一家医院首次癫痫发作服务机构就诊的首次无诱因发作的成人进行前瞻性队列研究。比较睡眠中与清醒时首次发作的临床特征和结局。
1312 例患者中，298 例（23%）首次无诱因发作发生在睡眠中，其中 1 年复发累积风险为 56.9%（95%置信区间[CI] 51.3-62.6），而清醒时首次发作的复发风险为 44.2%（95% CI 41.1-47.3，p<0.0001）。睡眠中首次发作是癫痫复发的独立预测因素，风险比[HR]为 1.44（95% CI 1.23-1.69），与 EEG 上的癫痫样异常（HR 1.48，95% CI 1.24-1.76）和远隔症状性病因（HR 1.47，95% CI 1.27-1.71）相似。对于无 EEG 癫痫样异常或远隔症状性病因的患者，睡眠中首次发作的复发风险 HR 为 1.97（95% CI 1.60-2.44），而清醒时首次发作的复发风险 HR 为 1.44。对于睡眠中首次发作，76%的第二次发作也来自睡眠（p<0.0001），65%的第三次发作（p<0.0001）也来自睡眠。睡眠中发作与除口咽创伤以外的损伤相关的可能性较小，无论是首发发作（9.4%比 30.6%，p<0.0001）还是首次复发（7.5%比 16.3%，p=0.001）。
首次无诱因的睡眠中发作更有可能复发，独立于其他危险因素，且通常也来自睡眠，癫痫相关损伤的风险较低。这些发现可能为首次发作后的治疗决策和咨询提供信息。
