Abstracts

Rationale: First epileptic seizures have been described in the general population. Our aim was to describe first unprovoked seizures in a homogenous population of young and generally healthy adults under prolonged stressful situations, recruited by law to the Israeli Defense Forces (IDF).Methods: The IDF medical database was searched for soldiers recruited between 2005 and 2013, who had a first unprovoked seizure during their service. Only individuals without prior history of seizures or those without seizures or treatment with antiepileptic drugs for at least one year prior to recruitment to the army were included in the study. The clinical data and military occupations of 139 soldiers, randomly chosen out of about 500 identified subjects, were retrospectively characterized.Results: 77% of the subject with a definable type of seizure presented with a generalized tonic-clonic seizure (GTCS) and of the individuals with determinable type of epilepsy 47% had primarily generalized and the rest focal epilepsy. 38% and 70% of the performed EEGs and MRIs were unremarkable, respectively. 26% of the seizures occurred during the initial training period. Treatment with an antiepileptic drug was initiated after the first seizure in 83% of cases, mostly with lamotrigine and valproic acid, in 34% and 32%, respectively. 25% of the subjects had additional seizures before their release from the army. Although subjects with a first seizure during initial training served longer periods before their release, only 20% of them had additional seizures, compared to 28% in the group of soldiers who experienced the first seizure after the training period.Conclusions: In this studied population, first unprovoked seizures were mostly GTCS, the vast majority of the subjects received antiepileptic drugs, and the risk of recurrence seemed lower after a first seizure that occurred during the most stressful initial training period. Further studies of the long term prognosis of a first seizure in this setting are indicated.