One-year outcome after a first clinically possible epileptic seizure: predictive value of clinical classification and
1Service de neurologie, CHU de Nancy, 29, avenue du Mal-de-Lattre-de-Tassigny, 54035 Nancy, France. l.maillard@chu-nancy.fr
Insights
Clinical criteria accurately predict epilepsy recurrence within one year for patients experiencing a first paroxysmal event. Positive criteria significantly increase recurrence risk, while negative criteria offer a high negative predictive value for epilepsy.
Area of Science:
- Neurology
- Emergency Medicine
- Clinical Diagnostics
Background:
- First-time paroxysmal events require accurate diagnosis to guide prognosis.
- Distinguishing epileptic seizures from other causes is crucial for patient management.
- Emergency room assessments for first-time events can be challenging.
Purpose of the Study:
- To evaluate the one-year outcomes for patients presenting with a first paroxysmal event.
- To assess the predictive value of clinical criteria for epilepsy recurrence and development.
- To analyze the impact of early EEG findings on prognosis.
Main Methods:
- Prospective observational cohort study of 175 adult patients with first paroxysmal events.
- Emergency room physicians used descriptive clinical criteria for initial assessment.
- Neurologists specialized in epilepsy conducted follow-up and final diagnoses.
- Kaplan-Meier estimates, log-rank tests, and Cox regression were used for risk analysis.
- Negative and positive predictive values (NPV and PPV) were calculated.
Main Results:
- Patients with positive clinical criteria had a 30% recurrence rate vs. 8% for negative criteria (RR=9.3).
- Subsequent epilepsy risk was 57% for positive criteria vs. 16% for negative criteria (RR=5.6).
- Clinical criteria showed a 93.2% NPV for recurrence and 83.5% for definite epilepsy.
- Early EEG abnormalities supported epileptic origin in 17% of uncertain cases and increased epilepsy risk (RR=2.50).
Conclusions:
- Clinical criteria provide valuable prognostic information at one year for first paroxysmal events.
- Positive clinical criteria strongly correlate with higher recurrence and epilepsy risk.
- Negative clinical criteria offer a high degree of certainty against recurrence.
- Future studies should incorporate clinical certainty levels and uncertain epileptic seizures for better outcome prediction.
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 1 year of significant factors were calculated.
Results:
Clinical criteria were positive in 67 patients and negative in 108. At 1 year, 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 1 year 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.
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