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1 *. : 4 :. 2 / 4 3 6/. ( /) : 6 / :. :. 0 :. International league Against Epilepsy (ILAE) First Unprovoked Seizure (FUS) 24 () (2) (). : -* : : E-mial: sinaloo@sums.ac.ir // : 83//20 :
2 . 4 : ). (2 9) 24.. :. ). Remote Symptomatic * (3).. : * Remote Symptomatic. () (6 8 9). 30 ( 0) (Unprovoked)
3 . ( ) 4 6/02 ± 4/ ( ) /2 ± / /3 ± /9. 9/2 ± 6/8-2/4 3/ / /2 2/8 3/ / /3 4/ 42/ 33/ < 3 > 3 < 0 > 0 ( 80) 6 4 ( ( 6/6) 3/4) ( /). ( 4) /4 ± / ( 22) ( 2) 3 ( 6/2). 33 ( 24) ( 44) 2 (8) ( 24) 24 () ) 24 (Todd) postictal (. MRI. : () MRI : 2. 2 (Kaplan- Meier Survival analysis). Cox s proportional P<0.0 Hazard. ( 49) 4 384
4 (3 2). : provoked 24 postictal. :2 P value 0/3 0/40 0/029 * -- 0/2 -- 0/9 0/069 0/322 0/29 0/93 0/69 0/882 0/026* 0/ 0/692 0/96 0/2 0/632 0/683 0/22 (Multivariable analysis using Cox) 9 % CI lower upper 0/23-6/03 0/88-/409 /-/ /94-2/ /6-2/088 0/998-/063 0/363-/39 0/3-/4 0/296-3/639 0/00-/84 0/339-3/28 /0-2/9 0/99-2/8 0/2-3/486 0/20-4/6 0/8-3/46 0/289-2/23 0/639 -/98 0/42 -/229 Rate ratio 2/0 2/064 2/83 /00 /388 /00 /0 /030 0/2 0/669 /038 0/890 /093 /9 /309 0/29 0/96 /26 0/84 /2 0/8 * Statistically significant () (4) 24 postictal Remote symptomatic provoked Reference category / Follow up (mount) (). : ( ) 2 Remote symptomatic seizure Idiopatihic seizure 26 :2 2 9 ) (Proportionate hazard)
5 -3 /03 48/9 80 6/ 3 4/3 8/6 2/4 2/ 30/3 3/ / 3/8 / 4/8 8/6 8/2 3/ ¼ / 9/6 32/4 8/6 3/ / / /3 6/6 4/6 6/6 2/3 6/6 3/3 0/ () / 2/8 38/ 6/ 64/3 3/ 30 62/8 30 / / 2/8 / 20 / /4 8/ 2/8 2/ 6/ 2/ Postictal provoked ( /9) ( 30) 2 ( 62/8) ( /) 4 69 ( 4 ) 3 ( 4) 3 ( 9/3). (8) 6. 4/3 Remote Symptomatic ( ( 3/) 86/8) / Remote Symptomatic 48/4.(2) (P=0/04) 38 ( /0) 6 ( 36/9) 384
6 Boulloche Shinnar (2 4 ). 22/ /. / ) Stroink (3). ( 4 /4 ± / (9 3)..( 92) ( 49) 4/) FUS ( 49/3 (9 6). 0 3 (2 6). ( 80) 64 Shinnar. (9). (%20) 36 9/6. 63/6.(P=/008) Cox hazard (9% /4. contidance interval) ( /) 22 ( 8/) 6 ( 2/3) 6 2/ 48..(p= 0/032) ( 8/6) 8 4 ( ) 38 ( 6/) (0/6) 44/. 6/.(p=0/044) 9 86/8) 26 ( 3/) Remote Symptomatic ( Remote Symptomatic ( 6) Shinnar ( 84) / (2 6 ). /8 ( /8) Comfield 2 (6 3) ( 4) Hans Stroink 384
7 . ( 0 ) 9/ (Cox ). 0/ Stroink. (6) (8 6) 0 FUS Shinnar. Remote Symptomatic (2).. (Remote Symptomatic) 48/4 (p=0/04) 3/ (2) 68 3 Shinnar (6). 4 0 Stroink. (84). Shinnar (Remote. Symptomatic seizure) (2). Hauser (). Stroink (3). 9 44/ FUS (6 9). 63/6 4/3 9/6 Stroink. (6) Shinnar ) 2 (. 32 4/3 (2 ) (9 20 2). 60/3 384
8 ( 3/. Shinnar (9 2). : 44/ FUS 4 ( 2) References. John H. Menkes and Raman Snaker. Text book of Child Neurology 6th ed. 2000: Commission on Epidemiology and prognosis. International league Against Epilepsy Guidelines for epidemiologic studies on epilepsy. Epilepsia 34 : (993) Annegers JF, Shirts SB, Hauser WA, Kurland LT: Risk of recurrence after on initial unprovoked seizure. Epilepsia 2: (986) Berg AT, Shinnar S: The risk of recurrence following a first unprovoked seizure: A quantitative review. Neurology 4: (99) Camfield PR, Camfield CS, Dooley JM, Tibbles JAR, Fung T, Garner B: A randomized study of carbamazepin versus no medication following a 6/ (p =/044). Provoked. Postictal 24 /) first unprovoked seizure in childhood. Neurology 39: (989) Camfield PR, Camfield CS, Dooley JM, Tibbles JAR, Fung T, Garner B: Epilepsy after a first unprovoked seizure in childhood. Neurology 3 : (98) Hauser WA, Anderson VE, Loewenson RB, MC Roberts SM: Seizure recurrence after a first unprovoked seizure. N Eng J Med 30: (982) Hopkins A, Garman A, Clarke C: The first seizure in adult life : value of clinical features electroencephalography and computerized tomographic scanning in prediction of seizure recurrence. Lancet : (988) Shinnar, S, Berg AT, Moshe SL, Petix M, 384
9 Maytol J, Kang H, Goldenohn E, Hanser A: The risk of recurrence following a first unprovoked seizure in childhood. A prospective study. Pediatrics 8S: 990; Committee on Drugs, American Academy of pediatrics. Behavioral & congenive effects of anticonvulsant therapy. Pediatrics, 96 (99) Dodson WE, Delorenzo RJ, Pedley TA, Santos CS: The treatment of convulsive status epilepticus: Recommendations of the Epilepsy foundation of American s working group on status epileptics. JAMA, 20 (993) Shinnar S, Berg AT, Moshe SL, O Dell C, Alemany M, Newstein D, Kong H, Goldensohn ES, Hauser A: The risk of seizure recurrence following a first unprovoked a febrile seizure in childhood. An extended follow up. Ped 98 (996) Commission on classification and terminology of International league Against Epilepsy. Proposal for revised classification of epilepsies and epileptic syndromes. Epilepsia 30 : (989) Shinnar S, Berg AT, O Dell C, Newstain D, Moshe SL, Hauser WA. Predictor of multiple seizures in a cohort of children prospectively followed from the time of their first unprovoked seizure, Ann Neurol 48; 2000; Boulloche- J; Le loup- P Mallet- E; Tran- P. Risk of recurrence single, unprovoked, generalize tonic-clonic seizure. Dev Med. Child Neurology 3; 989; (): Straink H, Brouwer of, Arts WE, Geerts AT, Peters AC, Van Donselaar CA: The first unprovoked seizure in childhood. A hospitalbased study of accuracy of the diagnosis, rate of recurrence, and long-term outcome after recurrence : Dutch study of epilepsy in childhood, J Neurol psychiatry 64 (998) Hirtz DG, Ashwal, Berg A, Bettis D, Camfield P, Crumrine P, Elterman R, Schneider S, Shirnar S: Practice parameter : Evaluating a first non febrile seizure in childhood : report of Quality standards subcommittee of the American Academy of Neurology, the child Neurology Society and the American Epilespy Society. Neurology : (2000) O Dell C, Shinnar S: Initiation and discontinuation of antiepileptics drugs. Neurologic clinics 9 (200) Shinnar S, Kang H, Berg AT, Goldensohn ES, Hauser WA, Moshe SL: EEG abnormality in children with a first unprovoked seizure. Epilepsia 3 (994) Musicco M, Beghi E, Solari A, Vianni F: For the first seizure Trial Group (first Group) : Treatment of first tonic- clonic seizure does not improve the prognosis of epilepsy, Neurology 4 (99) Shinnar S, Berg AT: Does antiepileptic drug therapy prevent the development of Chronic epilepsy. Epilepsia 3 (996)
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