Risk of seizure recurrence after multiple seizures within 24 hours

Australian researchers have found that adult patients presenting with multiple seizures within 24 hours are no more likely to have seizure recurrence than those presenting with a single seizure.According to the Commission of Epidemiology and Prognosis of the International League Against Epileps, multiple seizures occurring in a 24-hour period are considered a single event, However, Dr Kho and colleagues from Perth say that the rationale for this recommendation, particularly in patients with a first-ever seizure, has not been systematically studied. Studies in children have shown that multiple seizures within 24 hours did not affect prognosis, but there is a lack of data in adults. "Previous studies have variously excluded these patients, regarded them as single seizures, analyzed them in conjunction with status epilepticus, or failed to specify how such patients were categorized," they say.Dr Kho and colleagues conducted a study to define the clinical features and prognosis of adult patients presenting with first-ever seizure and experiencing two or more seizures within 24 hours. Between January 1999 and April 2004, 497 adult patients with first-ever seizure referred to the clinics at the Royal Perth and Fremantle Hospitals were included in the study. Of these, 72 (14%) had multiple seizures within 24 hours. The majority of seizures were generalised tonic-clonic seizures. The overall seizure recurrence rate at one year was 38%; on stepwise logistic regression, remote symptomatic etiology was independently predictive of recurrence. The authors report, "There was no significant difference in seizure recurrence between the multiple and single seizure groups at 12 months, irrespective of the etiologic diagnosis and irrespective of whether they were treated." Treated patients had a higher seizure recurrence rate, irrespective of whether they first presented with single or multiple seizures. The authors say this is consistent with the greater likelihood that patients with remote symptomatic etiology were treated.Reference...