Hauser W A, Rich S S, Lee J R, Annegers J F, Anderson V E
G.H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.
N Engl J Med. 1998 Feb 12;338(7):429-34. doi: 10.1056/NEJM199802123380704.
Patients with a single unprovoked seizure have about a 35 percent risk of recurrence in the subsequent five years. We studied the risk of recurrence after two unprovoked seizures.
We prospectively followed 204 patients with a first unprovoked seizure from the day of the initial seizure. Information was obtained from patients (and verified by a review of their medical records) about the dates and circumstances of any subsequent seizures. The risk of a second, third, and fourth seizure was estimated by the Kaplan-Meier method.
Of the 204 patients, 63 had a second seizure, 41 a third seizure, and 26 a fourth seizure. The mean age of the patients was 36 years, 10 percent were less than 16 years of age, 70 percent were male, 71 percent had epilepsy of unknown cause, and 66 percent had generalized seizures. The risk of a second unprovoked seizure was 33 percent. Among those with a second seizure, the risk of a third unprovoked seizure was 73 percent; among those with a third unprovoked seizure, the risk of a fourth was 76 percent. Most recurrences occurred within one year of the second or third seizure. The risk of a third seizure was higher in those with a presumed cause of epilepsy (relative risk, 1.9; 95 percent confidence interval, 1.0 to 3.4).
Although only about one third of patients with a first unprovoked seizure will have further seizures within five years, about three quarters of those with two or three unprovoked seizures have further seizures within four years.
单次无诱因发作的患者在随后五年内复发风险约为35%。我们研究了两次无诱因发作后的复发风险。
我们对204例首次无诱因发作的患者从发作当日开始进行前瞻性随访。从患者处获取（并通过查阅病历进行核实）任何后续发作的日期和情况。采用Kaplan-Meier方法估计第二次、第三次和第四次发作的风险。
204例患者中，63例出现第二次发作，41例出现第三次发作，26例出现第四次发作。患者的平均年龄为36岁，10%年龄小于16岁，70%为男性，71%病因不明的癫痫，66%为全身性发作。第二次无诱因发作的风险为33%。在出现第二次发作的患者中，第三次无诱因发作的风险为73%；在出现第三次无诱因发作的患者中，第四次发作的风险为76%。大多数复发发生在第二次或第三次发作后的一年内。有癫痫假定病因的患者第三次发作的风险更高（相对风险，1.9；95%置信区间，1.0至3.4）。
虽然首次无诱因发作的患者中只有约三分之一会在五年内再次发作，但有两次或三次无诱因发作的患者中约四分之三会在四年内再次发作。
