Presence of interictal epileptiform EEG discharges implies increased risk of recurrence after the first unprovoked seizure: Report of the International League Against Epilepsy and International Federation of Clinical Neurophysiology

IF 2 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice Pub Date : 2025-01-01 DOI:10.1016/j.cnp.2025.07.007

Betül Baykan , John Dunne , Samuel Wiebe , Louis Maillard , Sandor Beniczky , Michalis Koutroumanidis , Margitta Seeck

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Abstract

Objective

A joint International Federation of Clinical Neurophysiology — International League Against Epilepsy (IFCN-ILAE) Taskforce was created to explore the published evidence for initial EEGs in the evaluation of patients who experienced their first unprovoked seizure, and to determine the diagnostic value of EEG in supporting the diagnosis of epilepsy.

Methods

We conducted a systematic literature review, with two independent authors screening each study. We extracted seizure recurrence data among patients with EEG showing interictal epileptiform discharges (IEDs) versus those with normal or nonspecific-abnormal EEG results. Random-effects meta-analyses of seizure recurrence in relation to IEDs was conducted in the included studies, calculating odds ratios (OR) with confidence intervals (CI) and diagnostic accuracy.

Results

A total of 4847 patients from 22 studies with variable follow-up durations were analysed. The random-effects pooled binary estimate of seizure recurrence was 47 % (95 % CI 40 %–55 %). The overall proportion with seizure recurrence was higher in patients with IEDs (60 %; 95 % CI 53 %–68 %) compared to those without (40 %; 95 % CI 33 %–48 %, p < 0.001). Random-effects meta-analysis showed that the presence of IEDs was associated with seizure recurrence (OR: 2.32, 95 % CI 1.69–3.17, p < 0.001). Subgroup analyses of adults and children showed that this difference remained significant in both groups: OR in children of 3.24 (95 % CI 2.19–4.79) and in adults of 1.55 (95 % CI 1.08–2.21). In eight studies (n = 1209, 923 children) patients remained untreated before the second seizure; the pooled probability of seizure recurrence in those with IED in these studies was no different than in studies in which some patients were treated.

Significance

In conclusion, the presence of IEDs in EEG recordings obtained after the first unprovoked seizure can help clinicians to confirm the clinical diagnosis of epilepsy after a first unprovoked seizure, according to the revised ILAE definition. These results support the relevance of IED detection on EEG as a predictor of seizure recurrence after a first unprovoked seizure. However, its prognostic value is influenced by age and other clinical factors.

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间歇期癫痫样脑电图放电的存在意味着首次非诱发性癫痫发作后复发的风险增加：国际抗癫痫联盟和国际临床神经生理学联合会的报告

目的成立国际临床神经生理学联合会-国际抗癫痫联盟（IFCN-ILAE）联合工作组，探讨已发表的脑电图在评估首次非诱发性癫痫发作患者中的证据，并确定脑电图在支持癫痫诊断中的诊断价值。方法我们进行了系统的文献综述，由两位独立作者对每项研究进行筛选。我们提取了脑电图显示间期癫痫样放电（IEDs）的患者与脑电图结果正常或非特异性异常的患者之间的癫痫复发数据。在纳入的研究中进行癫痫发作复发与ied相关的随机效应荟萃分析，计算优势比（OR）、置信区间（CI）和诊断准确性。结果共分析了22项不同随访时间的4847例患者。随机效应汇总二值估计癫痫复发率为47% （95% CI为40% - 55%）。发作复发的总体比例在ied患者中（60%;95% CI 53% - 68%）高于无ied患者（40%;95% CI 33% - 48%, p < 0.001）。随机效应荟萃分析显示，ied的存在与癫痫发作复发相关（OR: 2.32, 95% CI 1.69-3.17, p < 0.001）。成人和儿童的亚组分析显示，两组的差异仍然显著：儿童OR为3.24 (95% CI 2.19-4.79)，成人OR为1.55 （95% CI 1.08-2.21）。在8项研究中（n = 1209,923名儿童），患者在第二次发作前未接受治疗；在这些研究中，IED患者癫痫发作复发的总概率与一些患者接受治疗的研究没有什么不同。总之，根据修订后的ILAE定义，在首次非诱发性癫痫发作后获得的脑电图记录中存在ied可以帮助临床医生确认首次非诱发性癫痫发作后癫痫的临床诊断。这些结果支持EEG上IED检测作为第一次非诱发性癫痫发作后癫痫复发的预测因子的相关性。但其预后价值受年龄及其他临床因素的影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Neurophysiology Practice NEUROSCIENCES-

CiteScore

3.90

自引率

0.00%

发文量

审稿时长

71 days

期刊介绍： Clinical Neurophysiology Practice (CNP) is a new Open Access journal that focuses on clinical practice issues in clinical neurophysiology including relevant new research, case reports or clinical series, normal values and didactic reviews. It is an official journal of the International Federation of Clinical Neurophysiology and complements Clinical Neurophysiology which focuses on innovative research in the specialty. It has a role in supporting established clinical practice, and an educational role for trainees, technicians and practitioners.