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The natural history and prognosis of epilepsy Volume 17, numéro 3, September 2015

TEST YOURSELF

(1) What is the overall relapse rate of a first unprovoked seizure? Also comment on observed differences between different studies.


(2) Can we identify different prognostic patterns in people with epilepsy?


(3) Does epilepsy carry a higher risk of premature death?

 

 

 

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Answers

(1) The overall risk of relapse after a first unprovoked seizure has been reported to range from 23 to 71%. The rates at two and five years are 21-69% and 34-71%, respectively. Differences are mostly explained by the population at risk, the duration of follow-up, and the methods used to assess the risk of seizure recurrence. Population studies provide more homogeneous relapse rates at one (36-37%) and two years (43-45%). In a systematic review of published reports, the average overall recurrence risk was 51% (95% CI: 49-53%).

(2) Yes. Population-based studies with long-term follow-up identify different prognostic patterns. These include early seizure remission followed by terminal remission, early seizure remission followed by seizure relapse and by a new period of remission (relapsing-remitting pattern), early seizure remission followed by seizure relapse with no further periods of remission, and early seizure recurrence followed by pharmacological and eventually terminal remission (delayed remission).

(3) Yes. As epilepsy may be the symptom of several clinical conditions, some of which are associated with a high risk of premature death, mortality in epilepsy is two- to three-fold higher and is frequently attributed to the underlying epileptogenic condition.

 

 

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