Baykan Betül, Dunne John, Wiebe Samuel, Maillard Louis, Beniczky Sandor, Koutroumanidis Michalis, Seeck Margitta
Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
EMAR Medical Centre, Istanbul, Turkey.
Clin Neurophysiol Pract. 2025 Aug 28;10:380-391. doi: 10.1016/j.cnp.2025.07.007. eCollection 2025.
A joint International Federation of Clinical Neurophysiology - International League Against Epilepsy (IFCN-ILAE) Taskforce was created to explore the published evidence for initial EEGs in the evaluation of patients who experienced their first unprovoked seizure, and to determine the diagnostic value of EEG in supporting the diagnosis of epilepsy.
We conducted a systematic literature review, with two independent authors screening each study. We extracted seizure recurrence data among patients with EEG showing interictal epileptiform discharges (IEDs) versus those with normal or nonspecific-abnormal EEG results. Random-effects meta-analyses of seizure recurrence in relation to IEDs was conducted in the included studies, calculating odds ratios (OR) with confidence intervals (CI) and diagnostic accuracy.
A total of 4847 patients from 22 studies with variable follow-up durations were analysed. The random-effects pooled binary estimate of seizure recurrence was 47 % (95 % CI 40 %-55 %). The overall proportion with seizure recurrence was higher in patients with IEDs (60 %; 95 % CI 53 %-68 %) compared to those without (40 %; 95 % CI 33 %-48 %, p < 0.001). Random-effects meta-analysis showed that the presence of IEDs was associated with seizure recurrence (OR: 2.32, 95 % CI 1.69-3.17, p < 0.001). Subgroup analyses of adults and children showed that this difference remained significant in both groups: OR in children of 3.24 (95 % CI 2.19-4.79) and in adults of 1.55 (95 % CI 1.08-2.21). In eight studies (n = 1209, 923 children) patients remained untreated before the second seizure; the pooled probability of seizure recurrence in those with IED in these studies was no different than in studies in which some patients were treated.
In conclusion, the presence of IEDs in EEG recordings obtained after the first unprovoked seizure can help clinicians to confirm the clinical diagnosis of epilepsy after a first unprovoked seizure, according to the revised ILAE definition. These results support the relevance of IED detection on EEG as a predictor of seizure recurrence after a first unprovoked seizure. However, its prognostic value is influenced by age and other clinical factors.
成立了国际临床神经生理学联合会 - 国际抗癫痫联盟（IFCN - ILAE）联合特别工作组，以探究已发表的关于首次无诱因发作患者评估中初始脑电图（EEG）的证据，并确定EEG在支持癫痫诊断方面的诊断价值。
我们进行了一项系统的文献综述，由两位独立作者筛选每项研究。我们提取了EEG显示发作间期癫痫样放电（IEDs）的患者与EEG结果正常或非特异性异常的患者的癫痫复发数据。对纳入研究中与IEDs相关的癫痫复发进行随机效应荟萃分析，计算优势比（OR）及置信区间（CI）和诊断准确性。
分析了来自22项研究的共4847例患者，随访时间各不相同。癫痫复发的随机效应合并二元估计值为47%（95%CI 40% - 55%）。与无IEDs的患者（40%；95%CI 33% - 48%，p < 0.001）相比，有IEDs的患者癫痫复发的总体比例更高（60%；95%CI 53% - 68%）。随机效应荟萃分析表明，IEDs的存在与癫痫复发相关（OR：2.32，95%CI 1.69 - 3.17，p < 0.001）。成人和儿童的亚组分析表明，两组中的这种差异均仍然显著：儿童的OR为3.24（95%CI 2.19 - 4.79），成人的OR为1.55（95%CI 1.08 - 2.21）。在八项研究（n = 1209，923名儿童）中，患者在第二次发作前未接受治疗；这些研究中有IEDs的患者癫痫复发的合并概率与一些患者接受治疗的研究中无异。
总之，根据修订后的国际抗癫痫联盟定义，首次无诱因发作后获得的EEG记录中IEDs的存在可帮助临床医生在首次无诱因发作后确认癫痫的临床诊断。这些结果支持EEG上IEDs检测作为首次无诱因发作后癫痫复发预测指标的相关性。然而，其预后价值受年龄和其他临床因素影响。
