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Department of Pediatrics (Dr. Berg), Yale University School of Medicine, New Haven, CT, and Departments of Neurology and Pediatrics, and the Montefiore/Einstein Epilepsy Management Center (Dr. Shinnar), Montefiore Medical Center, The Albert Einstein College of Medicine, Bronx, NY.
Knowledge of the recurrence risk following a first unprovoked seizure and the predictors of that risk are necessary for rational treatment decisions. Published estimates of recurrence risk range from 23 % to 71%. In a meta-analysis of 16 reports, three methodologic factors explained much of the reported variation: (1) study inclusion criteria, ie, whether patients were enrolled at the time of their first seizure or if patients with prior seizures were included; (2) retrospective versus prospective ascertainment of patients; (3) the interval between the first seizure and the time at which risk was assessed. The average recurrence risk across the 16 studies was 51%. The risk was 40% and 52% in prospective and retrospective studies that employed first-seizure methods and 67% in non-first seizure studies. At or near 2 years following the first seizure, the recurrence risk was 36% and 47% in prospective and retrospective first-seizure studies. The distribution of prognostic factors was also important. Seizure etiology and the EEG were the strongest predictors of recurrence distinguishing between patient subgroups, with recurrence risks as low as 24% and as high as 65%. Partial seizures were associated with an increased recurrence risk, but not consistently. There is considerable agreement among studies concerning the recurrence risk following a first seizure, and much of the discrepancies among studies can be explained by differences in study methods and distributions of important prognostic factors.
Address correspondence and reprint requests to Dr. Anne T. Berg, Department of Pediatrics, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06511.
Supported in part by a FIRST Award 1 R29 NS277728 (A.T. Berg) and grant 1 RO1 NS26151 (S. Shinnar) from the National Institute of Neurological Disorders and Stroke.
Received September 5, 1990. Accepted for publication in final form December 19, 1990.
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