What are the recurrence risks for adult seizures in patients with epileptiform discharges on EEG?

Updated: Nov 30, 2017
  • Author: Eissa Ibrahim AlEissa, MD, MBBS; Chief Editor: Selim R Benbadis, MD  more...
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In patients with a first seizure and no known etiology, van Donselaar et al’s pooled analyses showed the following 2-year cumulative risks of seizure recurrence [18] : in patients with epileptiform discharges, 83%; in patients with nonepileptiform abnormalities, 41%; and in patients with normal electroencephalogram (EEG), 12%. The investigators obtained a routine EEG in all cases and a second sleep-deprived EEG if the first EEG did not show epileptiform discharges.

Studies in the 1990s also reported the following risks for seizure recurrence:

  • Epileptiform discharges were associated with a 1.5- to 3-fold increase in the risk of seizure recurrence. [9, 12, 19]

  • A generalized spike and wave on EEG increased the risk of recurrent seizure in patients with no known etiology. [11]

  • An abnormal EEG finding and the presence of an underlying etiology (remote symptomatic) are the most consistent predictors of recurrence. [19]

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