Habermehl Lena, Linka Louise, Krause Kristin, Fuchs Alena, Weil Jenny, Gurschi Mariana, Zahnert Felix, Möller Leona, Menzler Katja, Knake Susanne
Epilepsy Center Hessen, Philipps-University Marburg, Marburg, Germany.
Epilepsy Center, Neurological Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, United States.
Front Neurol. 2025 Mar 24;16:1564680. doi: 10.3389/fneur.2025.1564680. eCollection 2025.
In 2014, the ILAE introduced a new definition of epilepsy that allows some patients to be diagnosed earlier than under the previously used definition. According to the old classification, the diagnosis was made after a second unprovoked seizure. The risk of this was 36% after the first seizure. The aim of this study is to investigate the clinical impact of the new definition on diagnosis, treatment, and short-term outcome.
From 2018 to 2021, adult patients admitted with a first epileptic seizure were prospectively included. Demographic and clinical data were collected at baseline, at 6 and 12 months follow-up (FU). Factors affecting seizure recurrence, especially age, use of anti-seizure medication (ASM), interictal epileptiform discharges (IED) in the EEG, and the presence of structural lesions on imaging were investigated.
Data from 235 patients were collected (41.7% female). Of these, 146 patients (62.1%) were diagnosed with epilepsy (PWE), following the new ILAE-criteria. Potential epileptogenic lesions on imaging were found in 49.3% of PWE. At the first FU (6.08 months ± 1.35), 143 patients (77.3%) were seizure-free, including 89 of the 146 patients diagnosed as PWE were seizure-free (70.6%). At the second FU (12.45 months ± 1.83), 129 patients (80.6%) were seizure-free. Seventy-seven of the PWE were seizure-free (72%). The use of ASM decreased (odds ratio = 0.46, = 0.004) the recurrence rate significantly.
Our results suggest that the new definition of epilepsy results in a higher frequency of epilepsy diagnosis and treatment. Short-term outcomes improved (1-year-recurrence rate of 19.4%).
2014年，国际抗癫痫联盟（ILAE）引入了癫痫的新定义，该定义使一些患者能够比使用先前定义时更早被诊断。根据旧分类，在第二次无诱因发作后才做出诊断。首次发作后发生第二次无诱因发作的风险为36%。本研究的目的是调查新定义对诊断、治疗和短期结局的临床影响。
前瞻性纳入2018年至2021年因首次癫痫发作入院的成年患者。在基线、6个月和12个月随访（FU）时收集人口统计学和临床数据。研究影响癫痫复发的因素，特别是年龄、抗癫痫药物（ASM）的使用、脑电图中的发作间期癫痫样放电（IED）以及影像学上结构性病变的存在情况。
收集了235例患者的数据（女性占41.7%）。其中，146例患者（62.1%）根据新的ILAE标准被诊断为癫痫（PWE）。49.3%的PWE在影像学上发现有潜在的致痫性病变。在首次随访（6.08个月±1.35）时，143例患者（77.3%）无癫痫发作，其中146例被诊断为PWE的患者中有89例无癫痫发作（70.6%）。在第二次随访（12.45个月±1.83）时，129例患者（80.6%）无癫痫发作。77例PWE无癫痫发作（72%）。ASM的使用显著降低了复发率（优势比=0.46，P=0.004）。
我们的结果表明，癫痫的新定义导致癫痫诊断和治疗的频率更高。短期结局得到改善（1年复发率为19.4%）。
