EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospitals of Geneva, Geneva, Switzerland.
Neuro-Critical Care Unit, Department of Intensive Care, University Hospitals of Geneva, Geneva, Switzerland.
Eur J Neurol. 2024 Feb;31(2):e16107. doi: 10.1111/ene.16107. Epub 2023 Oct 27.
Several studies found that patients with new-onset epilepsy (NOE) have higher seizure recurrence rates if they presented already prior seizures. These observations suggest that timing of antiseizure medication (ASM) is crucial and should be offered immediately after the first seizure. Here, we wanted to assess whether immediate ASM is associated with improved outcome.
Single-center study of 1010 patients (≥16 years) who presented with a possible first seizure in the emergency department between 1 March 2010 and 1 March 2017. A comprehensive workup was launched upon arrival, including routine electroencephalography (EEG), brain computed tomography/magnetic resonance imaging, long-term overnight EEG and specialized consultations. We followed patients for 5 years comparing the relapse rate in patients treated within 48 h to those with treatment >48 h.
A total of 487 patients were diagnosed with NOE. Of the 416 patients (162 female, age: 54.6 ± 21.1 years) for whom the treatment start could be retrieved, 80% (333/416) were treated within 48 h. The recurrence rate after immediate treatment (32%; 107/333) was significantly lower than in patients treated later (56.6%; 47/83; p < 0.001). For patients for whom a complete 5-year-follow-up was available (N = 297, 123 female), those treated ≤48 h (N = 228; 76.8%) had a significantly higher chance of remaining seizure-free compared with patients treated later (N = 69; 23.2%; p < 0.001).
In this retrospective study, immediate ASM therapy (i.e., within 48 h) was associated with better prognosis up to 5 years after the index event. Prospective studies are required to determine the value of immediate workup and drug therapy in NOE patients.
几项研究发现，新发癫痫（NOE）患者如果已经出现过发作，其癫痫复发率更高。这些观察结果表明，抗癫痫药物（ASM）的时机至关重要，应在首次发作后立即提供。在这里，我们想评估立即使用 ASM 是否与改善预后相关。
这是一项单中心研究，纳入了 2010 年 3 月 1 日至 2017 年 3 月 1 日期间在急诊科就诊的 1010 例（≥16 岁）疑似首次发作的患者。患者到达后立即进行全面检查，包括常规脑电图（EEG）、脑计算机断层扫描/磁共振成像、长时间夜间 EEG 和专门的咨询。我们对患者进行了 5 年的随访，比较了在 48 小时内接受治疗的患者与治疗时间超过 48 小时的患者的复发率。
共有 487 例患者被诊断为 NOE。在 416 例（162 名女性，年龄：54.6±21.1 岁）可获取治疗开始时间的患者中，80%（333/416）在 48 小时内接受了治疗。立即治疗后的复发率（32%；107/333）明显低于延迟治疗者（56.6%；47/83；p<0.001）。对于完成了完整 5 年随访的患者（N=297，123 名女性），在≤48 小时内接受治疗（N=228；76.8%）的患者与延迟治疗者（N=69；23.2%）相比，无癫痫发作的可能性显著更高（p<0.001）。
在这项回顾性研究中，立即 ASM 治疗（即，在 48 小时内）与指数事件后 5 年内更好的预后相关。需要前瞻性研究来确定在 NOE 患者中立即进行检查和药物治疗的价值。
