Prognosis and management of acute symptomatic seizures: a prospective, multicenter, observational study

作者：Julia Herzig-Nichtweiß, Farid Salih, Sascha Berning, Michael P. Malter, Johann Pelz, Piergiorgio Lochner, Matthias Wittstock, Albrecht Günther, Angelika Alonso, Hannah Fuhrer, Silvia Schönenberger, Martina Petersen, Felix Kohle, Annekatrin Müller, Alexander Gawlitza, Waldemar Gubarev, Martin Holtkamp, Bernd J. Vorderwülbecke · 发表于：Annals of Intensive Care · 年份：2023 · DOI：10.1186/s13613-023-01183-0 · 被引用次数：36 · 研究领域：Epilepsy research and treatment、Psychosomatic Disorders and Their Treatments、Pharmacological Effects and Toxicity Studies

BACKGROUND: Acute symptomatic epileptic seizures are frequently seen in neurocritical care. To prevent subsequent unprovoked seizures, long-term treatments with antiseizure medications are often initiated although supporting evidence is lacking. This study aimed at prospectively assessing the risk of unprovoked seizure relapse with respect to the use of antiseizure medications. It was hypothesized that after a first acute symptomatic seizure of structural etiology, the cumulative 12-month risk of unprovoked seizure relapse is ≤ 25%. METHODS: Inclusion criteria were age ≥ 18 and acute symptomatic first-ever epileptic seizure; patients with status epilepticus were excluded. Using telephone and mail interviews, participants were followed for 12 months after the acute symptomatic first seizure. Primary endpoint was the occurrence and timing of a first unprovoked seizure relapse. In addition, neuro-intensivists in Germany were interviewed about their antiseizure treatment strategies through an anonymous online survey. RESULTS: Eleven of 122 participants with structural etiology had an unprovoked seizure relapse, resulting in a cumulative 12-month risk of 10.7% (95%CI, 4.7%-16.7%). None of 19 participants with a non-structural etiology had a subsequent unprovoked seizure. Compared to structural etiology alone, combined infectious and structural etiology was independently associated with unprovoked seizure relapse (OR 11.1; 95%CI, 1.8-69.7). Median duration of antiseizure treatment ...