Idiopathic first seizure in adult life: who should be treated?

Abstract

be managed conservatively.3" Our results suggest that not only will 16% of carcinomas be misdiagnosed but a huge burden of outpatient consultations will result if the three monthly follow up policy is adhered to. This conservative policy is also unacceptable to most patients. " The previous policy of our unit to excise all discrete lumps occurring in the under 36 age group, whatever the preoperative diagnosis, would seem to be supported by our figures. A total of 9768 patients aged under 36 with benign breast disease were seen over the 19 years. If each of these patients had had a discrete lump and had had surgical excision the operative burden would have been 10 cases a week. Tru-Cut biopsy could be used to provide tissue provided that representative samples are obtained. Most patients, however, prefer surgical excision. " Our current policy is to perform fine needle aspiration in all women with clinically discrete breast masses. Combined ultrasonography and radiography is also performed in all patients with a discrete mass. If the results of combined mammography are equivocal compression paddle radiographs are taken. As soon as the results are available the patient is reviewed in an assessment clinic. Any concern over the nature of the mass results in excision biopsy being performed (figure).We suggest that centres not possessing adequate cytological and combined mammographic facilities should excise all discrete breast masses in this age group without previous investigation. We also suggest that the poor detection rate by general practitioners warrants all young patients presenting with a breast lump being referred to a surgeon with an interest in breast disease. Idiopathic first seizure in adult life: who should be treated?Cees A van Donselaar, Ada T Geerts, Robert-Jan Schimsheimer Abstract Objective-To assess the accuracy of the diagnosis, recurrence rate, and fate after the first recurrence in adult patients with an untreated idiopathic first seizure.

Single seizure and epilepsy in patients with a cerebral territorial infarct

“…The recurrence rate of an idiopathic untreated, isolated seizure in adult life is found around 40% [20]. This corresponds approximately to what we found in our stroke patients with a territorial infarct.…”

The role of sleep electroencephalography in patients with new onset epilepsy

“…Epileptiform abnormalities identified in the first routine interictal electroencephalography (EEG) were reported to vary between 20 and 50% in suspected epilepsy in both adults and children [1][2][3][4][5][6]. The diagnostic yield of routine EEG should therefore be increased by repetitive EEG recordings and additive use of activation methods.…”

Interobserver reliability of visual interpretation of electroencephalograms in children with newly diagnosed seizures

“…EEG findings are used for the classification of epileptic syndromes and may determine the choice of anti-epileptic drugs. The presence of epileptiform discharges is a strong predictor for the risk of recurrence after a first seizure (Berg and Shinnar 1991, van Donselaar et al 1991, Stroink et al 1998.…”