FIRST SEIZURE CLINIC EXPERIENCE: HETEROGENEITY OF PATIENT POPULATION AND PROGNOSIS
Abstract number :
3.248
Submission category :
Year :
2005
Submission ID :
6054
Source :
www.aesnet.org
Presentation date :
12/3/2005 12:00:00 AM
Published date :
Dec 2, 2005, 06:00 AM
Authors :
1,2Srinivasa R. Yerra, 1Christine Kilpatrick, 3Marienne Hibbert, 3Caroline Brand, 1Zelko Matkovic, and 1,2Terence O[apos]Brien
Around 4% of people experience one or more seizures in their lifetime. Only handful of studies examined the issue of first seizure, which presents unique challenges in terms of definitive diagnosis, prognostication and management. First seizure remains a controversial topic, with different studies reporting differing results because of variations in study inclusion criteria, case ascertainment and sample size. This study presents 6-year experience of a dedicated First Seizure Clinic run by epileptologists. First Seizure Clinic was established in 1999. Patient were referred from general practitioners in the community and emergency and other departments of our hospital. A prospective database of all attendees to the clinic incorporating demographic, clinical, EEG, and neuroimaging data has been maintained since 2000. The data was comprehensively analyzed to define characteristics and outcomes of attendees to the clinic. Data was available for analysis in a total of 415 patients. People with existing diagnosis of epilepsy were excluded. Events were diagnosed as epileptic seizures in 325 (78%), as non-epileptic events in 58 (14%) and as uncertain in 31(8%). Seizures were thought to be provoked in 79 (24%) and unprovoked in 246 (76%). Follow up data was available on 295 patients (89%) with median follow up of 175 days (25th-75th percentile: 87-707 days) for all attendees to the clinic, and 244 (87-497) for those with epileptic seizure at presentation. Of patients with an unprovoked seizure, 64 (26%) had recurrent seizures. Median number of days to recurrent seizure was 227 (91-489). A lower recurrence rate was seen in patients with provoked seizure, 12 of 79 (15.1%, p= 0.049; Fisher exact test, one tailed). At least a quarter of patients will have further seizures following presentation with first epileptic seizure. Seizure recurrence is less following provoked seizure. The data should provide useful information to the clinicians in counseling such patients. (Srinivasa Raju Yerra is a full time research and clinical fellow in epilepsy with University of Melbourne and his research is supported by Royal Melbourne Hospital Neuroscience foundation, a not for profit research foundation.)