Article
Prognosis of acute symptomatic seizures due to structural brain damage
Prognose strukturell bedingter akut-symptomatischer Anfälle
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Published: | May 25, 2022 |
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Objective: Neurosurgical conditions and interventions are often complicated by acute symptomatic seizures. These bear a low risk of subsequent unprovoked seizures (<20% per 10 years) which means that they are not to be mistaken with epilepsy. In epilepsy, the risk of subsequent unprovoked seizures is >60% per 10 years (Hesdorffer 2009 Epilepsia). Current guidelines recommend to not apply long-term antiseizure medication after acute symptomatic seizures which is nevertheless frequently started (Vorderwülbecke 2018 J Neurol). Former studies did not control for the use of antiseizure medication. We hypothesised that after a first acute symptomatic seizure of structural aetiology treated according to current guidelines, the 12-months risk of unprovoked seizure relapse is <25%.
Methods: We present a multicentre, prospective, single-arm, open observational study. Subjects aged ≥18 with an acute symptomatic first seizure were included if there was no status epilepticus. Patients are followed up during their intra- and posthospital course for a total of 12 months. Unprovoked seizure relapse is the study’s primary endpoint. The study was prospectively registered in the German Clinical Trials Register (DRKS00017811).
Results: Between September 2019 and July 2021, 10 centres across Germany recruited 115 patients with acute symptomatic seizures of structural aetiology. As of January 2022, across the whole study cohort including 66 participants with complete follow-up (57%), nine had an unprovoked seizure relapse. The resulting Kaplan-Meier estimator at 12 months is at 11%. Ongoing antiseizure medication did not prevent unprovoked seizures. By the time of the DGNC congress in May 2022, follow-up will be completed in >90% of participants.
Conclusion: Our data confirm that acute symptomatic seizures due to recent structural brain damage may not be confused with epilepsy. In times of personalised medicine, physicians should refrain from initiating long-term antiseizure treatment after acute symptomatic seizures.