Predicting Seizure Recurrence: New Research Reveals Key Prognostic Factors

Strategic Insights -

Researchers at Homerton University Hospital have published a systematic review in the Cochrane Database of Systematic Reviews, identifying several factors that may increase the risk of seizure recurrence after a first unprovoked seizure. The study, which pooled data from 23 studies involving over 5,900 participants, found that abnormal EEG readings, low-certainty evidence suggests abnormal brain imaging, nocturnal seizures, family history of epilepsy, and Todd's paresis may increase seizure recurrence risk.

Key Takeaways:

  • Abnormal EEG readings (RR 1.90, 95% CI 1.60 to 2.25) and abnormal brain imaging (RR 2.19, 95% CI 1.74 to 2.76) are associated with increased risk of seizure recurrence.
  • Nocturnal seizures (HR 1.41, 95% CI 1.13 to 1.75) and family history of epilepsy (RR 1.47, 95% CI 1.16 to 1.85) may also increase seizure recurrence risk.
  • Todd's paresis (RR 1.48, 95% CI 1.02 to 2.13) may be associated with increased seizure recurrence risk, but findings remain uncertain due to limitations in study quality and consistency.
  • Febrile seizures (RR 1.02, 95% CI 0.82 to 1.28), focal neurological deficit (HR 1.21, 95% CI 0.92 to 1.60), status epilepticus (RR 1.05, 95% CI 0.81 to 1.36), male sex (RR 1.14, 95% CI 0.94 to 1.39), initial focal seizures (OR 1.19, 95% CI 0.77 to 1.85), and age under 16 years (OR 1.80, 95% CI 1.16 to 2.79) are associated with unclear or low-certainty evidence of increased seizure recurrence risk.
  • Prognostic factors predicting seizure recurrence are essential for guiding clinical decisions, shaping healthcare policy, and enabling recruitment into trials of disease-modifying treatments.
  • The study highlights the need for standardization of reporting and collection of prognostic factor data to enhance comparability and reliability.

Statistics:

  • 23 studies (5918 participants) were included in the systematic review.
  • Median follow-up was 35 months (range six to 283 months).
  • Seven studies included participants on anti-seizure medication (ASM) after their first seizure; 16 did not.
  • Eight studies were adult-only, 12 paediatric-only, and three included both age groups.
  • Using the QUIPS tool, nine studies (39%) had a low risk of bias, 11 (48%) unclear, and three (13%) high.

Sources:

  • Cochrane Database of Systematic Reviews (2025;10)
  • Prognostic factors predicting an unprovoked seizure recurrence in children and adults following a first unprovoked seizure.
  • Researchers from Homerton University Hospital (2025)
  • NewsRx. Researchers from Homerton University Hospital Report Recent Findings in Seizures (Prognostic factors predicting an unprovoked seizure recurrence in children and adults following a first unprovoked seizure). Health & Medicine Week. October 24, 2025; p 577.