TOPLINE

Three-year follow-up data confirmed a low risk for later unprovoked seizures after an acute symptomatic seizure, even when the seizure had a structural aetiology. However, male sex, epileptiform EEG activity, and an interval of 48 hours or longer between the onset of the underlying condition and the onset of seizures were associated with a higher risk for later unprovoked seizures.

METHODOLOGY

• Researchers analysed data from a prospective, multicentre, observational study conducted at 10 study centres in Germany to assess the risk for unprovoked seizures during the second and third years after a first acute symptomatic seizure.
• They enrolled 141 patients after a first acute symptomatic seizure between 2019 and 2021, of whom 122 had acute symptomatic seizures with a structural cause, including stroke, intracerebral or subarachnoid haemorrhage, central nervous system infection with brain lesions, or cerebral venous thrombosis.
• The primary outcome was the occurrence of an unprovoked seizure over a follow-up duration of 36 months. The chance of occurrence of a seizure in the next year (COSY) was estimated to determine driving eligibility.

TAKEAWAY

• In patients with acute symptomatic seizures of structural aetiology, the 3-year cumulative incidence of unprovoked seizures was 14% (95% CI, 7%-21%) after accounting for death as a competing risk.
• Male sex (hazard ratio [HR], 9.3; P = .01), epileptiform activity on EEG (HR, 7.4; P = .01), and a latency of 48 hours or more between the onset of the underlying condition and the onset of seizures (HR, 4.8; P = .02) were independent risk factors for unprovoked seizures.
• Treatment duration of antiseizure medications (ASMs) was not associated with the risk for later unprovoked seizures.
• COSY fell from 10% at the time of the seizure to 0% by 24 months, with patients eligible for private driving (COSY < 20%) immediately after an acute seizure and for professional driving (COSY < 2%) after a median seizure-free interval of 20 months.

IN PRACTICE

"Individual risk factors such as male sex, epileptiform activity on the initial EEG, and extended time intervals between the occurrence of the underlying condition and the ASySs [acute symptomatic epileptic seizures] should be considered when assessing prognosis and making treatment decisions. However, there is still no clear evidence favoring prolonged ASM treatment," the authors wrote.

SOURCE

This study was led by Bernd J. Vorderwülbecke, Epilepsy-Center Berlin-Brandenburg, Charité - Universitätsmedizin Berlin, Berlin, Germany. It was published online on October 8, 2026, in Epilepsia.

LIMITATIONS

Patients who were not enrolled or were lost to follow‑up were significantly older than participants who completed follow‑up, suggesting selection bias. The specific timing of starting ASMs was not evaluated. Some epileptic seizures might not have been reported due to self-reporting bias.

DISCLOSURES

No study funding was reported. Several authors declared receiving consulting fees, speaker honoraria, travel reimbursements, and/or payments for presentations, lectures, and podcasts from various pharmaceutical companies. One author declared holding stocks in different pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.