Objective:

To determine the incidence and predictors of seizure recurrence following a first unprovoked seizure in adults, with emphasis on demographic, clinical, and diagnostic factors influencing recurrence risk.

Background:

The management of patients after a first unprovoked seizure remains controversial. While some individuals experience no recurrence, others develop epilepsy, making it crucial to identify high-risk patients. Prior studies suggest that age, EEG abnormalities, and structural brain lesions are associated with recurrence, but their predictive value varies across populations. This study aimed to evaluate these predictors in a South Asian cohort to enhance risk stratification and guide therapy decisions.

Design/Methods:

We retrospectively analyzed 1,596 adults (≥18 years) who presented with a first unprovoked seizure at Liaquat University of Medical & Health Sciences Hospital, Jamshoro, and were followed for at least 12 months. Demographic data, comorbidities, EEG findings, neuroimaging results, and treatment patterns were collected. Multivariate logistic regression identified predictors of seizure recurrence, expressed as odds ratios (OR) with 95% confidence intervals (CI). Statistical significance was set at p < 0.05.

Results:

Over a median 12-month follow-up, 30.5% of patients experienced seizure recurrence. Younger age (<20 years) was associated with higher recurrence (OR 1.60, p = 0.02). Abnormal EEG (OR 2.80, p < 0.001) and structural brain lesions (OR 3.40, p < 0.001) were the strongest predictors. Comorbid stroke (OR 3.90, p < 0.001) and depression or anxiety (OR 2.40, p < 0.001) also increased risk. Initial use of antiepileptic drugs (AEDs) reduced recurrence (OR 0.40, p < 0.001). Monotherapy yielded better outcomes (28.0%) than polytherapy (63.6%).

Conclusions:

Nearly one-third of adults experienced seizure recurrence within one year after a first unprovoked event. EEG abnormalities, structural lesions, and comorbid neurological or psychiatric disorders were strong independent predictors. Early identification of these factors and appropriate AED monotherapy can improve prognosis and guide individualized management following a first seizure.