Document Detail


One-year outcome after a first clinically possible epileptic seizure: Predictive value of clinical classification and early EEG.
MedLine Citation:
PMID:  23181965     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
OBJECTIVE: To assess the one-year outcome of patients referred to the emergency room for a first paroxysmal event of clinically certain or uncertain epileptic origin.
METHODS: This prospective observational cohort study included 175 adult patients who were consecutively referred for a first paroxysmal event and excluding clinically certain syncope faints. Simple descriptive clinical criteria were used by emergency room physicians for epileptic assessment. Follow-up and final diagnosis were made by neurologists specialized in epilepsy. The risk of recurrence and epilepsy over time was described using Kaplan-Meier estimates. The effect of risk factors (including EEG results) was assessed using univariate log-rank tests and a Cox regression multivariate model. Negative and positive predictive values (NPV and PPV) at 1year of significant factors were calculated.
RESULTS: Clinical criteria were positive in 67 patients and negative in 108. At 1year, the rate of recurrence was respectively 8% in the negative clinical criteria group (NCC) and 30% in the positive clinical criteria group (PCC) (RR=9.3; 95% CI=[1.22; 71.4]). The risk of subsequent epilepsy was respectively 16% in the NCC group and 57% in PCC group (RR=5.6; 95% CI=[2.0; 15.6]). Positive predictive value (PPV) of clinical criteria was 28.8% for recurrence and 57.6% for definite epilepsy. Negative predictive value (NPV) of clinical criteria was 93.2% for recurrence and 83.5% for definite epilepsy. The presence of significant abnormalities on early EEG (paroxysms or focal abnormalities) supported an epileptic origin in 17% of clinically uncertain seizures. It was associated with a higher risk of subsequent epilepsy (RR=2.50; 95% CI [1.37; 4.41]; P=0.007), but did not significantly improve the PPV of clinical criteria alone.
CONCLUSION: These results may help provide a prognosis at 1year after a first paroxysmal event of certain or uncertain epileptic origin. Future studies focusing on the outcome after a first epileptic seizure should take into consideration the degree of certainty of the clinical diagnosis and integrate the group of patients with uncertain epileptic seizure.
Authors:
L Maillard; J Jonas; R Boyer; S Frismand; G Mathey; J-P Vignal; F Guillemin; M Maignan; H Vespignani
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Publication Detail:
Type:  Journal Article     Date:  2012-08-18
Journal Detail:
Title:  Neurophysiologie clinique = Clinical neurophysiology     Volume:  42     ISSN:  1769-7131     ISO Abbreviation:  Neurophysiol Clin     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-11-27     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8804532     Medline TA:  Neurophysiol Clin     Country:  France    
Other Details:
Languages:  eng     Pagination:  355-62     Citation Subset:  IM    
Copyright Information:
Copyright © 2012. Published by Elsevier SAS.
Affiliation:
Service de neurologie, CHU de Nancy, 29, avenue du Mal-de-Lattre-de-Tassigny, 54035 Nancy, France; Faculté de médecine, université de Lorraine, Nancy, France; CRAN, UMR 7039, CNRS, INPL, université de Lorraine, Nancy, France. Electronic address: l.maillard@chu-nancy.fr.
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