Abstracts

Rationale: The management of the first unprovoked seizure is still a challenge. According to the new ILAE classification is possible to diagnose epilepsy only with one unprovoked seizure and a 60% or more risk of recurrence of seizures in the next years. Methods: We analyzed 40 patients without previous diagnosis of epilepsy, who develop the first unprovoked seizure, between September 2015 to June 2016.  We evaluated the ictal semiology, EEG, brain images and the final diagnosis. All patients had, at list, one brain image (CT scan in 38 patients and MRI in 28 patients). EEG was performed in 34 of 40 patients.  Results: Our patients had an average age of 50 years (SD 20), and 21 were men. 80% of patients had focal seizures. 48% patients had an abnormal CT, showing an epileptogenic lesion. MRI was valuable in patients with normal CT (2 abnormal MRI of 16 patients with normal CT). The most frequent etiology of the epilepsy was stroke, and the second one, brain tumors. Abnormal neuroimaging was more frequent in older patients (50 years or more, p < 0,05). EEG was abnormal, showing epileptiform discharges in 16 of 34 patients; and abnormal without epileptiform discharges in 7 of 34 patients. 50% (8 of 16) of patients with abnormal epileptiform EEG had a normal neuroimaging. In 82,5% of our patients was possible to made the diagnosis of epilepsy, even without a second seizure. Conclusions: In our population, a high percent of patients with a first unprovoked seizure had a final diagnosis of epilepsy. CT scan was appropriate for the initial management of this patients, and EEG was helpful in cases with normal neuroimages. The availability of this methods early contributes to the initial diagnostic and treatment of patients.  Funding: No