Newly Diagnosed Unprovoked Epileptic Seizures: Presentation at Diagnosis in CAROLE Study

Abstract

Summary:Purpose: We describe first unprovoked seizures and newly diagnosed epilepsies at initial presentation, with a special emphasis on epilepsy syndromes, in a large cohort recruited in the mid-1990s in France.Methods: The French Foundation for Research on Epilepsy set up a network to conduct a prospective study of patients with newly diagnosed unprovoked seizures. Information was provided by 243 child or adult neurologists. Four neurologists classified each case according to the International League Against Epilepsy (ILAE) criteria. First-seizure patients and patients with previously undiagnosed seizures were compared.Results: Between May 1, 1995, and June 30, 1996, 1,942 patients aged from 1 month to 95 years were identified: 926 (47.7%) with a single seizure and 1,016 (52.3%) with newly diagnosed epilepsy. All but 17 patients had EEGs. In the firstseizure and newly-diagnosed-epilepsy groups, neuroimaging studies were performed in 78.2 and 68.3% of patients, and medication prescribed in 54.1 and 89.6%, respectively. There were significant differences between the two groups with respect to age at onset and diagnosis, sex, etiology, several specific syndromes, as well as the type and presentation of initial seizure. In patients for whom the first seizure was convulsive, only sex, multiple seizures in a day or status epilepticus, and cryptogenic localization-related syndrome differed between the two groups.Conclusions: Approximately half of patients who first came to attention for an unprovoked seizure already met epidemiologic criteria for epilepsy. There were significant differences between the types of patients with a first seizure and those with newly diagnosed epilepsy. One or several seizures at diagnosis did not influence the diagnostic assessment of the patients but had a strong influence on the initiation of treatment.

Priorities in pediatric epilepsy research

“…Epidemiologic evidence demonstrates that relatively subtle seizure types may go undetected for long periods of time, even years. 9 A quarter (27%) of children with infantile spasms were not brought to their physician for .2 months in one study. 10 Longer delays to initial diagnosis were associated with poorer developmental outcomes in early childhood.…”

“…Subtle seizures are often not recognized initially and may persist for months or years before being diagnosed. 9,10 Seizures are also underrecognized in children who are developmentally impaired 11 although overdiagnosed in children with autism. 12 Parent and family.…”

Practice Parameter: Evaluating an apparent unprovoked first seizure in adults (an evidence-based review): [RETIRED]

“…Studies of individuals presenting with presumed new onset seizures report that about 50% of these individuals, after careful history and questioning, actually have had previous seizures and merit a diagnosis of epilepsy. 11 Although the recurrence rates differ in individuals after a first seizure as opposed to a new diagnosis of epilepsy, both patient groups are at significant risk for seizure recurrence. 2 We also excluded adults presenting with a seizure as a known consequence of an acute condition such as immediate cerebral trauma or stroke.…”

Classification of the epilepsies: New concepts for discussion and debate—Special report of the ILAE Classification Task Force of the Commission for Classification and Terminology

“…This group accounts for a quarter of all epilepsies 26. The collective name “idiopathic generalized epilepsies” (IGE) encompasses the syndromes of childhood absence epilepsy (CAE), juvenile absence epilepsy (JAE), juvenile myoclonic epilepsy (JME), and epilepsy with generalized tonic‐clonic seizures alone (EGTCS) as well as some cases that do not fit into one of these clearly defined syndromes.…”