Diagnostic decision-making after a first and recurrent seizure in adults

Askamp, Jessica; Putten, Michel Johannes Antonius Maria van

doi:10.1016/j.seizure.2013.03.012

Cited by 16 publications

(17 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Epileptiform EEG changes played a lesser role than neuroimaging abnormalities in influencing treatment commencement and remained less influential than other risk factors in those with normal imaging and a single seizure. This observation might reflect inherent differences in weighting ascribed by neurologists to different investigations in the treatment decision process . Although EEG has consistently been associated with a higher risk of recurrence after a first seizure, its role in our cohort might have been to clarify electroclinical diagnosis when other data were noncontributory and not a predictor of treatment in our study.…”

Section: Discussionmentioning

confidence: 88%

“…This observation might reflect inherent differences in weighting ascribed by neurologists to different investigations in the treatment decision process. 26 Although EEG has consistently been associated with a higher risk of recurrence after a first seizure, 27 its role in our cohort might have been to clarify electroclinical diagnosis when other data were noncontributory and not a predictor of treatment in our study. In our cohort where all patients were diagnosed with epilepsy, a higher proportion of patients had epileptogenic lesions (over 40%) identified on neuroimaging compared to similar cohorts.…”

Section: Discussionmentioning

confidence: 88%

See 1 more Smart Citation

Treatment initiation decisions in newly diagnosed epilepsy–A longitudinal cohort study

et al. 2020

View full text Add to dashboard Cite

Objective To examine the factors and reasons influencing treatment initiation decisions in patients with newly diagnosed epilepsy. Methods We assessed antiseizure medication initiation decisions in adults with newly diagnosed epilepsy seen at first seizure clinics in Western Australia between 1999 and 2016 and followed to 2018. Results Of 610 patients (median age 40 years, 61.0% male), 426 (69.8%) were diagnosed after two or more seizures and 184 (30.2%) after a single seizure with risk factors for recurrence. Treatment was commenced in 427 patients (70.0%) at diagnosis, 112 (18.4%) during follow‐up, mostly after further seizures, whereas 71 (11.6%) remained untreated at last follow‐up. Elders (≥65 years, odds ratio [OR] = 3.06, 95% confidence interval [CI]: 1.62‐5.80), more seizures (OR = 3.48, 95% CI: 2.03‐5.96), and epileptogenic lesions on neuroimaging (OR = 2.15, 95% CI: 1.26‐3.68) had a higher likelihood of treatment at diagnosis. Patients with less than one seizure per year within the preceding year (OR = 0.40, 95% CI: 0.21‐0.73) and of higher socioeconomic status (OR = 0.985, 95% CI: 0.977‐0.994) were less likely to be treated. For 93 patients (15.2%), treatment was not recommended at diagnosis, most commonly because only a single seizure had occurred. Ninety patients (14.8%) declined recommended treatment, mostly because they were unconvinced of the need for treatment or the diagnosis. Significance Thirty percent of adults with newly diagnosed epilepsy were not immediately treated. Treatment initiation in this real‐world cohort was influenced by age, number of seizures prior to diagnosis, imaging findings, patient preferences, and socioeconomic status.

show abstract

Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 88%

Treatment initiation decisions in newly diagnosed epilepsy–A longitudinal cohort study

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Se ha demostrado que las llamadas "crisis sintomáticas remotas" (aquellas debidas a enfermedad vascular cerebral, trauma, infección del sistema nervioso central, parálisis cerebral y trastornos cognitivos del desarrollo) duplican el riesgo para recurrencia de crisis, lo cual quedó demostrado desde el estudio de Hauser y colaboradores, en el cual la tasa de recurrencia de crisis en epilepsias sintomáticas remotas al 1, 3 y 5 años fue de 26%, 41% y 48% respectivamente, comparado con el 10%, 24% y 29% en el mismo intervalo de pacientes con epilepsia de causa desconocida (15). La probabilidad estimada de recurrencia de crisis después de la primera crisis en adultos con anormalidades epileptiformes en el EEG es 49,5% comparado a sólo 27,4% en individuos con EEG normal (16). De la misma manera, la injuria cerebral como causa de una crisis fue asociada con un incremento en el riesgo de recurrencia de crisis entre el primer y quinto año de 2.55 (IC 95%: 1,44-4,51), comparado con el riesgo de pacientes con crisis de causa desconocida (13,15).…”

Section: Riesgo De Recurrencia De Crisis Después De Una Primera Crisiunclassified

Manejo de primera crisis afebril:Importancia del enfoque clínico

Toro-Pérez¹,

Custodio

2017

Rev Neuropsiquiatr

View full text Add to dashboard Cite

RESUMENUna crisis epiléptica es un evento traumático físico como psicológico que plantea dificultades en el diagnóstico y muchas interrogantes para el tratamiento agudo y en el largo plazo. La recurrencia de una crisis epiléptica origina aún más serios y costosos problemas en la vida personal, familiar y laboral del individuo afectado. En estas circunstancias, un correcto abordaje del manejo de individuos con una primera crisis afebril debe ser una prioridad de los sistemas de salud con el objetivo fundamental de prevención de recurrencias. La elección de un fármaco antiepiléptico va a depender de una detallada anamnesis del evento clínico y de la información proveniente de estudios o tests neurofisiológicos y por exámenes de imágenes cerebrales.PALABRAS CLAVE: Anti-epilépticos, crisis epiléptica, diagnóstico, epilepsia, tratamiento. SUMMARYSeizures or an epileptic crisis is a traumatic event, both of physical and psychological nature that poses difficulties in the diagnostic process and many questions for its immediate and long-term management. The recurrence of an epileptic crisis causes even more serious and costly problems in the personal, family and work life of the affected individual. Due to this, a correct approach to the management of patients with a first afebrile crisis must be a priority of the health systems, with the primary purpose of preventing recurrences. The choice of an anti-epileptic drug will depend on a detailed anamnesis of the clinical event and onthe information from neurophysiological tests and brain imaging studies

show abstract

“…EEG is used in clinical practice, research and various other domains. Its numerous applications contain pre-surgical evaluation [1], diagnostic decision-making [2] and the assessment of chronic headaches [3]. EEG "is an important diagnostic tool for patients with seizures and other paroxysmal behavioral events" [4], it may provide diagnostic information in case of epilepsy [5], Alzheimer's disease [6], [7], schizophrenia [8] or after a brain injury [9].…”

Section: Introductionmentioning

confidence: 99%

Classification of Electroencephalograph Data: A Hubness-aware Approach

2016

APH

View full text Add to dashboard Cite

show abstract

Diagnostic decision-making after a first and recurrent seizure in adults

Cited by 16 publications

References 25 publications

Treatment initiation decisions in newly diagnosed epilepsy–A longitudinal cohort study

Treatment initiation decisions in newly diagnosed epilepsy–A longitudinal cohort study

Manejo de primera crisis afebril:Importancia del enfoque clínico

Classification of Electroencephalograph Data: A Hubness-aware Approach

Contact Info

Product

Resources

About