New York, NY Feb. 11, 1998-- Two or three unprovoked seizures may greatly increase the risk for more seizures and should be necessary criteria for diagnosing epilepsy, according to a study by researchers at Columbia University's College of Physicians and Surgeons. The study, published in the Feb 12 New England Journal of Medicine, establishes the first mathematically sound definition of epilepsy. The data could lead to a better understanding of seizure occurance and more appropriate treatment intervention.
Epilepsy, a condition that affects approximately 2.5 million Americans, is a condition characterized by recurrent unprovoked seizures. "There has been a debate in the medical community about how many seizures that means and when a person should be treated for epilepsy," says W. Allen Hauser, M.D., lead author and professor of neurology and public health in the Gertrude H. Sergievsky Center at Columbia-Presbyterian. "This study shows that two seizures are necessary and sufficient criteria for defining epilepsy. It provides a prediction of risk of seizure recurrence for people newly diagnosed with epilepsy."
The study, funded in part the National Institute of Neurological Disorders and Stroke, followed 204 patients for a mean of eight years, beginning at the diagnosis of their first unprovoked seizure. Only one-third of the original group had more seizures within five years. However, once patients had a second seizure, their risk of a third jumped to 73 percent. Patients who had three seizures had a 76 percent risk of a fourth.
"Once a patient has a second seizure, the risk of having a third or fourth is quite high," says Dr. Hauser. "So the implication is that patients should be treated after their second seizure." In the United States, approximately 150,000 people are diagnosed with epilepsy each year.
Other investigators are Steven Rich, Ph.D.; Ju R.-J. Lee, Ph.D.; John Annegers, Ph.D.; and V. Elving Anderson, Ph.D.
The Neurological Institute (NI) at Columbia-Presbyterian Medical Center treats more cases of neurological dysfunction than any other teaching hospital in the world.
The Comprehensive Epilepsy Center at Columbia-Presbyterian Medical Center provides multidisciplinary diagnostic and treatment services to patients with epilepsy and is a major referral site for patients with uncontrollable seizures. Epilepsy is the third most common neurological disorder after stroke and Alzheimer's disease, and is probably the one most misunderstood by the public.
NI's Comprehensive Epilepsy Center is shedding new light on every aspect of this disease, from its molecular level to its social impact. The Center has played a major role in every clinical trial for antiepileptic drugs; initiated computer analysis of seizure mechanisms; carried out innovative epidemiological studies to evaluate relationships between epilepsy and alcoholism, or high risk environments such as the inner city; and identified genetic factors attached to variations of the disease. Clinicians in the Institute's surgical epilepsy seizure program can trace the cause of convulsive episodes to a precise location in the brian. Once identified, the offending tissue is removed with exacting skill--halting or reducing the patient's seizures.
The Gertrude H. Sergievsky Center at Columbia-Presbyterian Medical Center focuses on epidemiologic approaches to the study of neurodevelopmental disorders.