Authors :
Presenting Author: Bernd Vorderwülbecke, MD – Charité - Universitätsmedizin Berlin
Hannah Traben, - – Charité - Universitätsmedizin Berlin; Sascha Berning, MD – Klinikum Osnabrück; Michael Malter, MD – University Hospital Cologne; Johann Pelz, MD – Leipzig University Medicine; Piergiorgio Lochner, MD – Saarland University Medical Center; Matthias Wittstock, MD – Rostock University Medical Center; Albrecht Günther, MD – Jena University Hospital; Angelika Alonso, MD – University Hospital Mannheim; Marko Blickhan, MD – Medical Center – University of Freiburg; Silvia Schönenberger, MD – Heidelberg University Hospital; Lisa Langenbruch, MD – Klinikum Osnabrück; Annekatrin Müller, MD – Leipzig University Medicine; Felix Kohle, MD – University Hospital Cologne; Frauke Röll, MD – Saarland University Medical Center; Waldemar Gubarev, MD – Rostock University Medical Center; Martin Holtkamp, MD – Charité - Universitätsmedizin Berlin; Farid Salih, MD – Charité - Universitätsmedizin Berlin; Julia Herzig-Nichtweiß, MD – Charité - Universitätsmedizin Berlin
Rationale:
Acute symptomatic seizures are epileptic seizures occurring during an acute disturbance of the brain. To avoid subsequent unprovoked seizures, long-term treatments with antiseizure medications are often initiated although supporting evidence is low. This study aimed at prospectively assessing the risk of unprovoked seizure relapse with respect to the use of antiseizure medications. It was hypothesized that after a first acute symptomatic seizure of structural etiology, the cumulative 12-month risk of unprovoked seizure relapse is ≤ 25%.
Methods:
We present a prospective, multicenter, single-arm, open observational study. Subjects aged ≥ 18 with an acute symptomatic first-ever seizure were included unless they had status epilepticus. Participants are followed up during their intra and post hospital course for a total of three years; the study’s primary endpoint is occurrence of an unprovoked seizure relapse within 12 months. The study was prospectively registered in the German Clinical Trials Register (DRKS00017811).
Results:
Between September 2019 and July 2021, ten centers across Germany recruited 141 participants. Etiology of their acute symptomatic seizure was structural in 122 and non-structural in 19. Three-year follow-up will be completed in July 2024. As of May 2023, 16 participants (11.3%) died and another 29 (20.6%) were lost to follow-up. Fifteen participants with structural etiology had a subsequent unprovoked seizure, resulting in a cumulative three year risk of 14.6% (95%-CI, 7.2-22%), whereas none of 19 participants with a non-structural etiology had an unprovoked seizure relapse (p = 0.19). Among structural etiologies, cumulative three year risk of unprovoked seizure relapse appears higher in combined structural and infectious pathologies (29.3%; 5-53.6%) and intracerebral hemorrhage/cerebral venous thrombosis (27%; 7-47%) than in ischemic stroke (10.3%; 0-21.7%; p = 0.12). Nine out of 15 participants (60%) had their unprovoked seizure relapse while still taking antiseizure medication.
Conclusions:
Overall, even in case of structural etiology, acute symptomatic seizures bear a low overall risk of subsequent unprovoked seizures. However, individual constellations with an increased risk of unprovoked seizure relapse need to be identified. The duration of treatment with antiseizure medications needs to be adapted to the individual risk profile.
Funding:
Not related to this study, FK was supported by the Köln Fortune Program, Faculty of Medicine, University of Cologne (472/2020); MH holds the ‘Friedrich von Bodelschwingh Endowed Professorship for Clinical and Experimental Epileptology’ at the Department of Neurology, Charité – Universitätsmedizin Berlin funded by v. Bodelschwingh Foundation; BJV received funding from the German Research Foundation (DFG 422589384) and the German Society for Epileptology (Otfrid Foerster scholarship, 2021).