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Previous Volume 338:429-434 February 12, 1998 Number 7 Next

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ABSTRACT

Background Patients with a single unprovoked seizure have about a 35 percent risk of recurrence in the subsequent five years. We studied the risk of recurrence after two unprovoked seizures.

Methods We prospectively followed 204 patients with a first unprovoked seizure from the day of the initial seizure. Information was obtained from patients (and verified by a review of their medical records) about the dates and circumstances of any subsequent seizures. The risk of a second, third, and fourth seizure was estimated by the Kaplan–Meier method.

Results Of the 204 patients, 63 had a second seizure, 41 a third seizure, and 26 a fourth seizure. The mean age of the patients was 36 years, 10 percent were less than 16 years of age, 70 percent were male, 71 percent had epilepsy of unknown cause, and 66 percent had generalized seizures. The risk of a second unprovoked seizure was 33 percent. Among those with a second seizure, the risk of a third unprovoked seizure was 73 percent; among those with a third unprovoked seizure, the risk of a fourth was 76 percent. Most recurrences occurred within one year of the second or third seizure. The risk of a third seizure was higher in those with a presumed cause of epilepsy (relative risk, 1.9; 95 percent confidence interval, 1.0 to 3.4).

Conclusions Although only about one third of patients with a first unprovoked seizure will have further seizures within five years, about three quarters of those with two or three unprovoked seizures have further seizures within four years.

Source Information

From the G.H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York (W.A.H.); the Departments of Public Health Sciences and Neurology, Bowman Gray School of Medicine, Winston-Salem, N.C. (S.S.R.); the Ischemia Research and Education Foundation, San Francisco (J.R.-J.L.); the School of Public Health, University of Texas, Houston (J.F.A.); and the Division of Epidemiology, University of Minnesota, Minneapolis (V.E.A.).

Address reprint requests to Dr. Hauser at the G.H. Sergievsky Center, 630 W. 168 St., New York, NY 10032.

Full Text of this Article

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Risk of Recurrent Seizures
Meade T.W., Wennberg R., Hauser W. A., Rich S. S., Lee J. R.-J.
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N Engl J Med 1998; 339:128-130, Jul 9, 1998. Correspondence

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