Prognosis and management of acute symptomatic seizures: a prospective, multicenter, observational study
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Published:2023-09-15
Issue:1
Volume:13
Page:
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ISSN:2110-5820
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Container-title:Annals of Intensive Care
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language:en
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Short-container-title:Ann. Intensive Care
Author:
Herzig-Nichtweiß JuliaORCID, Salih FaridORCID, Berning Sascha, Malter Michael P.ORCID, Pelz Johann O.ORCID, Lochner PiergiorgioORCID, Wittstock MatthiasORCID, Günther AlbrechtORCID, Alonso AngelikaORCID, Fuhrer HannahORCID, Schönenberger SilviaORCID, Petersen Martina, Kohle FelixORCID, Müller AnnekatrinORCID, Gawlitza Alexander, Gubarev Waldemar, Holtkamp MartinORCID, Vorderwülbecke Bernd J.ORCID,
Abstract
Abstract
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 was 3.4 months (IQR 0–9.3). Seven out of 11 participants had their unprovoked seizure relapse while taking antiseizure medication; longer treatment durations were not associated with decreased risk of unprovoked seizure relapse. Following the non-representative online survey, most neuro-intensivists consider 3 months or less of antiseizure medication to be adequate.
Conclusions
Even in case of structural etiology, acute symptomatic seizures bear a low risk of subsequent unprovoked seizures. There is still no evidence favoring long-term treatments with antiseizure medications. Hence, individual constellations with an increased risk of unprovoked seizure relapse should be identified, such as central nervous system infections causing structural brain damage. However, in the absence of high-risk features, antiseizure medications should be discontinued early to avoid overtreatment.
Funder
Deutsche Gesellschaft für Neurointensiv- und -Notfallmedizin DGNI Medizinische Fakultät der Albert-Ludwigs-Universität Freiburg Faculty of Medicine, University of Cologne v. Bodelschwingh Foundation Deutsche Forschungsgemeinschaft Deutsche Gesellschaft für Epileptologie Charité - Universitätsmedizin Berlin
Publisher
Springer Science and Business Media LLC
Subject
Critical Care and Intensive Care Medicine
Reference44 articles.
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