{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T02:06:14Z","timestamp":1782698774610,"version":"3.54.5"},"reference-count":42,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2018,12,27]],"date-time":"2018-12-27T00:00:00Z","timestamp":1545868800000},"content-version":"vor","delay-in-days":26,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epileptic Disorders"],"published-print":{"date-parts":[[2018,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:p><jats:italic>Aims<\/jats:italic>. The risk of seizure recurrence after a first unprovoked seizure is influenced by certain risk factors. To understand their effect in people with early diagnosed new epilepsy, we assessed the risk of recurrence of focal to bilateral tonic\u2010clonic or generalized tonic\u2010clonic seizures and the associated factors in a clinically well\u2010characterized cohort of adults with a first unprovoked tonic\u2010clonic seizure.<\/jats:p><jats:p><jats:italic>Methods<\/jats:italic>. We prospectively studied 150 consecutive adults with a first unprovoked tonic\u2010clonic seizure and full clinical, EEG, and brain imaging assessment within the first four weeks. New epilepsy was diagnosed and classified according to the International League Against Epilepsy criteria. Time to second focal to bilateral tonic\u2010clonic or generalized tonic\u2010clonic seizure was analysed using the Kaplan\u2010Meier method.<\/jats:p><jats:p><jats:italic>Results<\/jats:italic>. Early diagnosis of new epilepsy, including type or syndrome and aetiology, was possible in 109 patients (72.7%). The diagnostic yield of sleep\u2010deprived EEG was high in both genetic and non\u2010genetic localized focal epilepsies. A second focal to bilateral tonic\u2010clonic or generalized tonic\u2010clonic seizure occurred in 100 patients (66.7%) during a three\u2010year mean observation period. The risk was higher in non\u2010genetic focal epilepsies and lower in genetic epilepsies. Concurrent absences or myoclonic seizures and a first occurrence after awakening were predictors of a second generalized tonic\u2010clonic seizure in patients with genetic generalized epilepsy, while diagnosis of temporal or frontal lobe epilepsy, focal EEG discharges, and focal changes on brain imaging were related to an increased risk of focal to bilateral tonic\u2010clonic seizure recurrence, showing additive effects. Identifiable modulators or triggers for the first tonic\u2010clonic seizure, early treatment, and older age showed inverse association.<\/jats:p><jats:p><jats:italic>Conclusions<\/jats:italic>. The risk of a second generalized or focal to bilateral tonic\u2010clonic seizure and the factors involved vary across epilepsy aetiologies and syndromes. Early diagnosis and classification of new epilepsy is possible in most patients and may enable important adjustments to their management and treatment.<\/jats:p>","DOI":"10.1684\/epd.2018.1014","type":"journal-article","created":{"date-parts":[[2019,8,2]],"date-time":"2019-08-02T13:24:29Z","timestamp":1564752269000},"page":"490-501","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Epileptology of the first tonic\u2010clonic seizure in adults and prediction of seizure recurrence"],"prefix":"10.1002","volume":"20","author":[{"given":"Michalis","family":"Koutroumanidis","sequence":"first","affiliation":[{"name":"Department of Clinical Neurophysiology and Epilepsy, Guy's &amp; St Thomas\u2019 NHS Foundation Trust and Institute of Psychiatry, Psychology &amp; Neuroscience, Division of Neuroscience, King's College London 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