ArticleAnnals of intensive care2023
Prognosis and management of acute symptomatic seizures: a prospective, multicenter, observational study.
Article in Annals of intensive care, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
What it found
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
15 citing papers in PubMed, 1 synthesis or guideline pooled it, 29 citations in OpenAlex.
- Duration of anti-seizure medicines started for acute symptomatic seizures due to acute meningitis: a systematic review and meta-analysis.BMC medicine · 2026Pooled it
- Post-stroke seizures: classification, risk prediction, and management.Frontiers in neurology · 2026Review
- EEG features in late-onset epilepsy: possible correlation with cognitive impairment.Brain communications · 2026Article
- Electroencephalography in stroke Care: From acute monitoring to Post-Stroke epilepsy.Clinical neurophysiology practice · 2026Review
- Risk of unprovoked seizures after discontinuation of antiseizure medication at discharge following acute symptomatic seizures.Epilepsia · 2025Article
- Management and Outcomes in Confirmed or Suspected Acute Symptomatic Seizure: Role of Structured Outpatient Care.Annals of clinical and translational neurology · 2025Article
- The impact of white matter lesions on seizure recurrence after first epileptic seizures in the elderly: a prospective study.Neurological research and practice · 2025Article
- The impact of the new definition of epilepsy on diagnosis, treatment, and short-term outcomes-A prospective study.Frontiers in neurology · 2025Article
- Article
- Predictive models for secondary epilepsy in patients with acute ischemic stroke within one year.eLife · 2024Article
- Article
- Antiseizure Medication Use and Outcomes After Suspected or Confirmed Acute Symptomatic Seizures.JAMA neurology · 2024Article
- Clinical approaches for poststroke seizure: a review.Frontiers in neurology · 2024Review
- Review
- Exit Strategy: Balancing the Risks and Rewards of Antiseizure Medication Withdrawal.Epilepsy currentsReview
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
19 authors at 9 institutions in 1 country.
Funding
Abstract
backgroundAcute symptomatic epileptic seizures are frequently seen in neurocritical care. To prevent subsequent unprovoked seizures, long-term treatments with antiseizure medications are often initiated although supporting evidence is lacking. 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%.
methodsInclusion criteria were age ≥ 18 and acute symptomatic first-ever epileptic seizure; patients with status epilepticus were excluded. Using telephone and mail interviews, participants were followed for 12 months after the acute symptomatic first seizure. Primary endpoint was the occurrence and timing of a first unprovoked seizure relapse. In addition, neuro-intensivists in Germany were interviewed about their antiseizure treatment strategies through an anonymous online survey.
resultsEleven of 122 participants with structural etiology had an unprovoked seizure relapse, resulting in a cumulative 12-month risk of 10.7% (95%CI, 4.7%-16.7%). None of 19 participants with a non-structural etiology had a subsequent unprovoked seizure. Compared to structural etiology alone, combined infectious and structural etiology was independently associated with unprovoked seizure relapse (OR 11.1; 95%CI, 1.8-69.7). Median duration of antiseizure treatment was 3.4 months (IQR 0-9.3). Seven out of 11 participants had their unprovoked seizure relapse while taking antiseizure medication; longer treatment durations were not associated with decreased risk of unprovoked seizure relapse. Following the non-representative online survey, most neuro-intensivists consider 3 months or less of antiseizure medication to be adequate.
conclusionsEven in case of structural etiology, acute symptomatic seizures bear a low risk of subsequent unprovoked seizures. There is still no evidence favoring long-term treatments with antiseizure medications. Hence, individual constellations with an increased risk of unprovoked seizure relapse should be identified, such as central nervous system infections causing structural brain damage. However, in the absence of high-risk features, antiseizure medications should be discontinued early to avoid overtreatment.
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