Risk of recurrence in patients with an unprovoked tonic–clonic seizure and generalized epileptiform discharges on EEG

摘要: Objective The decision to initiate treatment in patients with a first unprovoked seizure remains controversial. Studies have reported a recurrence rate ranging from 21%–50%, but most have included patients with different etiologies, electroencephalography (EEG) findings, and seizure types. This study aimed to determine the risk of recurrence in patients with a first unprovoked generalized tonic–clonic (GTC) seizure with evidence of generalized spike–wave discharges (GSWDs) on EEG and compare the efficacy of antiseizure medications (ASMs) in preventing recurrence. Methods This prospective study included consecutive patients who presented with a single GTC seizure, evidence of GSWDs on EEG, and a follow‐up period of at least 1 year. All patients underwent extensive evaluation, including a 3‐hour sleep‐deprived video‐EEG recording and an epilepsy protocol brain magnetic resonance imaging (MRI …