The second unprovoked seizure in a cohort of treated patients with a first unprovoked seizure

OBJECTIVES: To evaluate the rate of a second unprovoked seizure in antiseizure medications (ASMs)-treated patients following a first unprovoked seizure and to identify potential risk factors associated with its occurrence. METHODS: A retrospective review of the computerized database and the medical records of all the patients who presented to our outpatient epilepsy clinic following admission and ASM initiation due to a first unprovoked seizure during a decade (2012-2021). RESULTS: The study group included 60 patients aged 18-84 years (mean: 40.8 years), 35 (58.3%) men. A second unprovoked seizure occurred in 43% of the patients at last observation. Seventy-five percent of the recurrences occurred at 3 years. Patients with a second unprovoked seizure were younger (32.9 vs. 46.9 years) (p = 0.010) and more likely to be women (64% vs. 28.6%) (p = 0.009) compared to patients without recurrent seizures. SIGNIFICANCE: Women and younger patients may deserve closer monitoring following a first unprovoked seizure. Further studies are needed to assess the efficacy of specific treatment strategies among all people with a first unprovoked seizure, with emphasis on younger adults and especially women.