Seizure recurrence after prolonged seizure control: Patterns and risk factors

2021 ◽  
Vol 124 ◽  
pp. 108330
Author(s):  
Hai Chen ◽  
Richard Amdur ◽  
Jennifer Pauldurai ◽  
Mohamad Koubeissi
Keyword(s):  
Risk Factors ◽  
Seizure Control ◽  
Seizure Recurrence ◽  
Prolonged Seizure ◽  
Control Patterns

scholarly journals Patterns of seizure control in patients with mesial temporal lobe epilepsy with and without hippocampus sclerosis

2015 ◽  
Vol 73 (2) ◽  
pp. 79-82 ◽  
Author(s):  
Ana Carolina Coan ◽  
Brunno M. Campos ◽  
Felipe P.G Bergo ◽  
Bruno Y. Kubota ◽  
Clarissa L. Yasuda ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Seizure Control ◽  
Hippocampal Sclerosis ◽  
Mesial Temporal Lobe Epilepsy ◽  
Similar Proportion ◽  
Seizure Freedom ◽  
Seizure Recurrence ◽  
Prolonged Seizure ◽  
Mesial Temporal Lobe

Objective Patients with mesial temporal lobe epilepsy (MTLE) may present unstable pattern of seizures. We aimed to evaluate the occurrence of relapse-remitting seizures in MTLE with (MTLE-HS) and without (MTLE-NL) hippocampal sclerosis. Method We evaluated 172 patients with MTLE-HS (122) or MTLE-NL (50). Relapse-remitting pattern was defined as periods longer than two years of seizure-freedom intercalated with seizure recurrence. “Infrequent seizures” was considered as up to three seizures per year and “frequent seizures” as any period of seizures higher than that. Results Thirty-seven (30%) MTLE-HS and 18 (36%) MTLE-NL patients had relapse-remitting pattern (X2, p = 0.470). This was more common in those with infrequent seizures (X2, p < 0.001). Twelve MTLE-HS and one MTLE-NL patients had prolonged seizure remission between the first and second decade of life (X2, p = 0.06). Conclusion Similar proportion of MTLE-HS or MTLE-NL patients present relapse-remitting seizures and this occurs more often in those with infrequent seizures.

The Risk of Seizure Recurrence After a First Unprovoked Afebrile Seizure in Childhood: An Extended Follow-up

PEDIATRICS ◽  
1996 ◽  
Vol 98 (2) ◽  
pp. 216-225 ◽  
Author(s):  
Shlomo Shinnar ◽  
Anne T. Berg ◽  
Solomon L. Moshe ◽  
Christine O'Dell ◽  
Marta Alemany ◽  
...  
Keyword(s):  
Risk Factors ◽  
Age Of Onset ◽  
Multivariable Analysis ◽  
Cumulative Risk ◽  
Febrile Seizures ◽  
Recurrence Risk ◽  
Early Recurrence ◽  
Seizure Recurrence ◽  
Unprovoked Seizure ◽  
History Of

Objective. To assess the long-term recurrence risks after a first unprovoked seizure in childhood. Methods. In a prospective study, 407 children who presented with a first unprovoked seizure were then followed for a mean of 6.3 years from the time of first seizure. Results. One hundred seventy-one children (42%) experienced subsequent seizures. The cumulative risk of seizure recurrence was 29%,37%,42%, and 44% at 1,2,5, and 8 years, respectively. The median time to recurrence was 5.7 months, with 53% of recurrences occurring within 6 months, 69% within 1 year, and 88% within 2 years. Only 5 recurrences (3%) occurred after 5 years. On multivariable analysis, risk factors for seizure recurrence included a remote symptomatic etiology, an abnormal electroencephalogram (EEG), a seizure occurring while asleep, a history of prior febrile seizures, and Todd's paresis. In cryptogenic cases, the risk factors were an abnormal EEG and an initial seizure during sleep. In remote symptomatic cases, risk factors were a history of prior febrile seizures and age of onset younger than 3 years. Risk factors for late recurrences (after 2 years) were etiology, an abnormal EEG, and prior febrile seizures in the overall group and an abnormal EEG in the cryptogenic group. These are similar to the risk factors for early recurrence. Conclusions. The majority of children with a first unprovoked seizure will not have recurrences. Children with cryptogenic first seizures and a normal EEG whose initial seizure occurs while awake have a particularly favorable prognosis, with a 5-year recurrence risk of only 21%. Late recurrences do occur but are uncommon.

scholarly journals Risk Factors of Seizure Recurrence After Antiepileptic Drug Withdrawal

2015 ◽  
Author(s):  
Mehmet Çeleğen ◽  
Ünsal Yılmaz ◽  
Gürkan Gürbüz ◽  
Kübra Çeleğen ◽  
Aycan Ünalp
Keyword(s):  
Risk Factors ◽  
Antiepileptic Drug ◽  
Drug Withdrawal ◽  
Seizure Recurrence ◽  
Antiepileptic Drug Withdrawal

scholarly journals Comparative efficacy of IV phenytoin, IV valproate and IV levetiracetam in childhood seizures

2019 ◽  
Vol 6 (4) ◽  
pp. 1592
Author(s):  
Sheeraz A. Dar ◽  
Wasim A. Wani ◽  
Mudasir Nazir ◽  
Zul Eidain Hussan
Keyword(s):  
Pediatric Patients ◽  
Seizure Control ◽  
Randomized Study ◽  
P Value ◽  
Age Group ◽  
Seizure Recurrence ◽  
Comparative Efficacy ◽  
Acute Setting ◽  
Neurologic Disorder

Background: Seizures are the most common pediatric neurologic disorder, with 4% to 10% of children suffering at least one seizure in the first 16 years of life objectives to compare efficacy of IV phenytoin, IV valproate, and IV levetiracetam in childhood seizures between 2months to 16 years of age.Methods: This prospective, randomized, study was done on pediatric patients in the age group of 2 months to 16 years who present actively convulsing to the emergency department of pediatrics.Results: At 24 hours seizures were controlled in 44 (88%) patients out of 50 patients in phenytoin group, 39 (78%) out of 50 patients in levetiracetam group and 46 (92%) out of 50 patients in valproate group (p-value 0.115). The relative risk of seizure recurrence for levetiracetam and phenytoin groups when compared to valproate was 2.75 and 1.5, respectively.Conclusions: Present study demonstrates that IV levetiracetam and IV valproate were comparable to IV phenytoin in terms of seizure control in acute setting. All the three are safe and efficacious. Time to regain consciousness was less in valproate group and long-term seizure control too was also better.

scholarly journals Is low antiepileptic drug dose effective in long-term seizure-free patients?

2003 ◽  
Vol 61 (3A) ◽  
pp. 566-573 ◽  
Author(s):  
Tânia A.M.O. Cardoso ◽  
Fernando Cendes ◽  
Carlos A.M. Guerreiro
Keyword(s):  
Risk Factors ◽  
Antiepileptic Drug ◽  
Randomized Study ◽  
Drug Dose ◽  
University Hospital ◽  
Seizure Recurrence ◽  
Partial Group ◽  
Group 2 ◽  
Group 1

OBJECTIVE: To investigate the value of leaving seizure-free patients on low-dose medication. METHOD: This was an exploratory prospective randomized study conducted at our University Hospital. We evaluated the frequency of seizure recurrence and its risk factors following complete or partial antiepileptic drug (AED) withdrawal in seizure free patients for at least two years with focal, secondarily generalized and undetermined generalized epilepsies. For this reason, patients were divided into two groups: Group 1 (complete AED withdrawal), and Group 2 (partial AED withdrawal). Partial AED withdrawal was established as a reduction of 50% of the initial dose. Medication was tapered off slowly on both groups. Follow-up period was 24 months. RESULTS: Ninety-four patients were followed up: 45 were assigned to complete (Group 1) AED withdrawal and 49 to partial (Group 2) AED withdrawal. Seizure recurrence frequency after two years follow-up were 34.04% in group 1 and 32.69% in Group 2. Survival analysis showed that the probability of remaining seizure free at 6, 12, 18 and 24 months after randomization did not differ between the two groups (p = 0.8). Group 1: 0.89, 0.80, 0.71 and 0.69; group 2: 0.86, 0.82, 0.75 and 0.71. The analysis of risk factors for seizure recurrence showed that more than 10 seizures prior to seizure control was a significant predictive factor for recurrence after AED withdrawal (hazard ratio = 2.73). CONCLUSION: Leaving seizure free patients on low AED dose did not reduce the risk for seizure recurrence. That is, once the decision of AED withdrawal has been established, it should be complete.

Ictal and Psychiatric Aspects of Suicide in Epileptic Patients

1992 ◽  
Vol 22 (3) ◽  
pp. 231-237 ◽  
Author(s):  
Mario F. Mendez ◽  
Robert C. Doss
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Major Depression ◽  
Seizure Control ◽  
Paranoid Schizophrenia ◽  
Psychotic Episode ◽  
Psychosocial Burden ◽  
Epileptiform Discharges ◽  
Epileptic Patients ◽  
Neurology Clinic

Objective: To evaluate the ictal and psychiatric aspects underlying the high risk of suicide among epileptic patients. Method: We surveyed the records of 1611 epileptic patients seen in a neurology clinic during an eight-year period, found four who died by suicide, and characterized their ictal and psychiatric features. Results: All four epileptic patients had partial complex seizures and temporal lobe foci. Two had an associated paranoid schizophrenia with suicidal ideation, and good or improving seizure control at the tine of their deaths. Another patient killed himself during a brief psychotic episode associated with increasing epileptiform discharges. The fourth patient had ictal depression and committed suicide during a flurry of partial complex seizures. Conclusions: These findings suggest that the high suicide rate among epileptic patients has a greater association with psychotic behaviors and psychic auras than with major depression or the psychosocial burden of being epileptic. We further review other reported risk factors for suicide in epilepsy.

scholarly journals New-onset seizure in HIV-infected adult Zambians

Neurology ◽  
2016 ◽  
Vol 88 (5) ◽  
pp. 477-482 ◽  
Author(s):  
Omar K. Siddiqi ◽  
Melissa A. Elafros ◽  
Christopher M. Bositis ◽  
Igor J. Koralnik ◽  
William H. Theodore ◽  
...  
Keyword(s):  
Risk Factors ◽  
Opportunistic Infections ◽  
Clinical Laboratory ◽  
Jc Virus ◽  
Seizure Recurrence ◽  
Onset Seizure ◽  
Karnofsky Score ◽  
Varicella Zoster ◽  
Identifiable Risk Factor ◽  
New Onset

Objective:To identify the etiology of new-onset seizure in HIV-infected Zambian adults and identify risk factors for seizure recurrence.Methods:A prospective cohort study enrolling HIV-infected adults with new-onset seizure within 2 weeks of index seizure obtained clinical, laboratory, and neuroimaging data to determine seizure etiology. Participants were followed to identify risk factors for seizure recurrence. Risk factors for mortality were examined as mortality rates were unexpectedly high.Results:Eighty-one patients with CSF for analysis were enrolled and followed for a median of 306 days (interquartile range 61–636). Most (91%) were at WHO stage III/IV and 66 (81%) had a pre-seizure Karnofsky score ≥50. Prolonged or multiple seizures occurred in 46 (57%), including 12 (15%) with status epilepticus. Seizure etiologies included CNS opportunistic infections (OI) in 21 (26%), hyponatremia in 23 (28%), and other infections in 8 (10%). OIs included Cryptococcus (17%), JC virus (7%) and 5% each for tuberculosis, cytomegalovirus, and varicella-zoster virus. No etiology could be identified in 16 (20%). Thirty (37%) patients died during follow-up and 20 (25%) had recurrent seizures with survival being the only identifiable risk factor.Conclusions:HIV-infected adults with new-onset seizure in Zambia often have advanced HIV disease with OI being the most frequent seizure etiology. Seizure recurrence is common but no risk factors for recurrence other than survival were identified. These findings suggest an urgent need for immune reconstitution in this population. Initiating treatment for seizure prophylaxis where only enzyme-inducing antiepileptic medications are available could threaten antiretroviral efficacy.

scholarly journals Electronic health record cue identifies epilepsy patients at risk for obstructive sleep apnea

2018 ◽  
Vol 8 (6) ◽  
pp. 468-471 ◽  
Author(s):  
Martha A. Mulvey ◽  
Aravindhan Veerapandiyan ◽  
David A. Marks ◽  
Xue Ming
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Electronic Health Record ◽  
Seizure Control ◽  
Health Record ◽  
Obstructive Sleep ◽  
Patients At Risk ◽  
Patients With Epilepsy

BackgroundPrior studies have reported that patients with epilepsy have a higher prevalence of obstructive sleep apnea (OSA) that contributes to poor seizure control. Detection and treatment of OSA can improve seizure control in some patients with epilepsy. In this study, we sought to develop, implement, and evaluate the effectiveness of an electronic health record (EHR) alert to screen for OSA in patients with epilepsy.MethodsA 3-month retrospective chart review was conducted of all patients with epilepsy >18 years of age who were evaluated in our epilepsy clinics prior to the intervention. An assessment for obstructive sleep apnea (AOSA) consisting of 12 recognized risk factors for OSA was subsequently developed and embedded in the EHR. The AOSA was utilized for a 3-month period. Patients identified with 2 or more risk factors were referred for polysomnography. A comparison was made to determine if there was a difference in the number of patients at risk for OSA detected and referred for polysomnography with and without an EHR alert to screen for OSA.ResultsThere was a significant increase in OSA patient recognition. Prior to the EHR alert, 25/346 (7.23%) patients with epilepsy were referred for a polysomnography. Postintervention, 405/414 patients were screened using an EHR alert for AOSA and 134/405 (33.1%) were referred for polysomnography (p < 0.001).ConclusionAn intervention with AOSA cued in the EHR demonstrated markedly improved identification of epilepsy patients at risk for OSA and referral for polysomnography.

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