Clinical and electroencephalographic correlations in patients with a first epileptic seizure

The problem of assessing the risk of a second epileptic seizure after a first unprovoked epileptic seizure is relevant. Assessing the risk of a second seizure is a difficult task, since epilepsy is a disease characterized by a pathological persistent predisposition of the brain to repeated seizures for any reason. This article describes the results of a dynamic study of clinical and electroencephalographic data in patients with a first unprovoked epileptic seizure. We examined 130 patients using clinical and neurological examination, electroencephalographic examination, video-EEG monitoring with obligatory sleep study, magnetic resonance imaging of the brain according to a special epileptic protocol with targeted examination of epileptogenic structures. Predictors of recurrent epileptic seizures and the development of locally determined epilepsy in patients with a first unprovoked epileptic seizure were identified. The presence of the identified predictors should be taken into account when determining treatment tactics and timely prescription of specific drug antiepileptic therapy.

TARGET. To study the characteristics and electroencephalographic data in the dynamics of the disease in patients with the first unprovoked epileptic seizure.

MATERIALS AND METHODS. The examination was carried out in 130 patients with the first unprovoked epileptic seizure (76 men and 54 women). The majority of patients (more than 70 %) were between the ages of 18 and 40. The presence of PNEP was established on the basis of such criteria as the occurrence of a seizure without regard to current cerebral pathology, as well as acute and/or chronic encephalopathy of toxic or dysmetabolic origin; no history of diseases that are predictors of epilepsy; no gross cerebral structural changes on MRI. The study did not include persons with current cerebral pathology or the development of an epileptic syndrome; in the presence of an epileptic reaction or provoked seizures; individuals with a previously diagnosed epilepsy.

RESULTS. It was found that the examined patients with PNEP have a number of features of neurological symptoms: in the shortest possible time after PNEP, cerebral symptoms prevailed over focal ones with the presence of hypertensivehydrocephalic syndrome in most cases. In addition, vegetative-dystonic syndrome was often determined. In terms of 3 to 6 months, cerebral symptoms also prevailed, but at a less significant level than in the shortest period after PNEP. During the observation period from 6 months to 1–1.5 years, there was some increase in focal neurological symptoms with a predominance of pyramidal insufficiency of varying severity.

CONCLUSIONS. Thus, the negative dynamics in the form of the formation of a persistent focus of epileptiform activity according to EEG monitoring data and the presence of structural changes on MRI in patients with the first unprovoked epileptic seizure can be considered as a reliable predictor of the occurrence of recurrent epileptic seizures and the development of locally caused epilepsy, which must be taken into account when determination of therapeutic tactics and timely appointment of specific drug AEP therapy.

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