Erster epileptischer anfall im erwachsenenalter: Überblick zu einem kontroversen thema

Counselling "first seizure" (FS) patients is a very complex issue. It implies a thoroughful diagnostic approach and a careful analysis of all related psychosocial sequels of the affected individual. Most relevant is the question of the estimated risk of seizure recurrence (SR). The available study data report a risk of SR of 27 to 78% within 3 to 5 years. This variation is mainly due to heterogeneous study designs. A recent metaanalysis calculated the risk of SR to be 40% within 2 to 4 years. Patients with evidence of symptomatic genesis (clinical findings, focal seizures, regional EEG changes and structural pathology in imaging studies) were at particular high risk for SR. According to our own prospective study, nearly half of all FS-patients show a structural abnormality when additional MRI is used. The need for MRI is stressed by the fact that in many patients subtle changes of the underlying detected diseases such as cerebrovascular lesions or a tumour prompt specific therapeutic strategies. Till now, the question of the necessity of antiepileptic treatment after a first seizure is not adequately addressed by the available studies and is part of an actual controversy. Though, there is striking evidence that the long-term prognosis of new-onset epilepsies is more determined by morphological abnormalities rather than by early treatment.