So in summary, the diagnostic investigation
of a patient with a first time seizure
is focused on figuring out the
risk of a second seizure event.
What is the risk of
a second seizure?
At 3 years in general,
the risk is 40%.
And we're using our
findings on history,
EEG and MRI
to determine whether that risk is
higher than 40% or lower than 40%.
Risk of a seizure with early and late
treatment is still around 76 to 77%.
So regardless of whether we
initiate early treatment or not,
the risk of a second
seizure is about the same.
And so typically, for a first time
seizure, we would not initiate treatment.
But there's some characteristics
that raise our concern.
So I'm going to walk through
a table that can help us to
see and understand
What we're looking at here is
the risk of a second seizure.
And again, we said the risk of a
second seizure in general is about 40%.
If we look on history about whether the
patient has a remote history of seizure.
If there's no history of
seizure, that risk stays at 40%.
If the patient has a
history of febrile seizures,
or a post traumatic seizure many years
ago, the risk goes up to 60%.
And we'd be more concerned.
When we think about
the seizure type,
a generalized seizure,
the risk of second seizure is 40%.
With a focal onset or partial onset
seizure, that risk is higher at 60%.
If the EEG is normal, our second
seizure risk goes down to 26%, it's low.
If abnormal, it's up to 56%.
And if we think about
the state of the patient
seizures happening out of
awakeness, that risk is low.
But out of sleep,
the risk of second seizure goes high.
we're using these findings
to determine what the risk
of a second seizure is,
and that will be used to calibrate
whether we want to start treatment or not.
The last thing we think about
when evaluating patients
with the first time
seizure is counselling.
And really counselling for the event
if a second seizure were to occur.
We think about
what patients should do and not do
given the risk of a potential seizure.
Seizure, first aid what a caregiver
should do at the time of a second seizure,
and in general
So how dangerous is a seizure?
Seizures actually aren't life
threatening in most situations.
In terms of the primary
risk of the seizure,
brain injury is unlikely
unless there's very prolonged
tonic-clonic activity or
severe status epilepticus.
Ictal apnea can occur,
but it's very rare except in neonates
and so patients usually don't
stop breathing during a seizure.
SUDEP which is sudden unexplained
death and epilepsy is a risk,
and that's the one life
threatening risk in epilepsy.
We don't know why patients die
in some situations with epilepsy.
That's why it's sudden
unexplained death in epilepsy.
This tends to be more common or
more commonly occur in patients
with refractory epilepsy that
occur frequently at night.
But in general, the risk of dying
during a seizure is very low.
There are potential
When patients are
bathing or swimming,
a seizure could cause them to drown or
patients could drown during their seizure.
When driving patients could
suffer from an accident.
And then there are various activities
where we would be concerned
if the patient lost consciousness
that could lead to injury.
And so when thinking
about seizure precautions,
we counselled them not to take
bus unattended or swim unattended.
Patients are not allowed to drive and
there's varying rules and regulations
about when patients can go back
to driving after a seizure.
And various activities where if the
patient were to lose consciousness
or have altered awareness,
we would counsel against those.
In terms of seizures at home,
we counsel patients on first aid
what to do if a seizure happens.
Patient should be placed
in a safe position,
typically on their lateral
side, laying on their side.
Patients and caregivers or caregivers
should clear everything out away
from the patient so they can't
hurt themselves during the event.
We ask family members not to restrain
movements or restrain patients
and not to stick anything
into a patient's mouth.
Patients may bite their tongue,
they won't bite their tongue off.
And with anything in their mouth
that won't prevent the tongue biting
just put them at risk for having an
injury from that being in their mouth.
And we ask family members to
stay away from the patient,
and about 90 to 95% of seizures will
resolve spontaneously within 1-3 minutes.
For patients with a first time
seizure who suffer a second seizure,
we would typically ask for the patient
to come in for emergent evaluation.
To evaluate what may be causing
that and to initiate treatment.
For patients with refractory
epilepsy that have frequent seizures.
Many stay at home during
or after a seizure
and can be managed over
the phone or in the clinic
for further evaluation
of their epilepsy.