DIAGNOSIS OF EPILEPSY AFTER FIRST SEIZURE.

INTRODUCING THE SWISS FIRST STUDY

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PROBLEM STATEMENT

Epilepsy affects around 0.7% of the population, i.e. 60’000 patients in Switzerland (8 Mio. citizens) and each year 4000 patients add to this number.

Isolated acute symptomatic seizures (e.g. due to alcohol withdrawal) or syncopes are much more frequent, i.e. around 10% of the population. In any case, over 90% of the patients are referred to an emergency department (ED), where the assessment of a first seizure constitutes a challenging task.

The first seizure can be the first of many others or remain the only one in the patient’s lifespan. Differential diagnosis encompasses psychogenic events, transient ischemic attacks, migraine, metabolic, vegetative and cardiac events.

Moreover, segregating acute symptomatic and unprovoked seizures remains difficult, since patient’s history can suggest provoked seizures even if there is no causal relationship and vice versa.

Currently, there are no reliable biomarkers allowing a correct classification of a first event as onset of epilepsy or as a non-epileptic event. In fact, while clinical history, EEG and neuroimaging are fundamental to achieve a correct diagnosis, not more than 50% are diagnosed appropriately.

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OUR GOALS AND OBJECTIVES

With our multicenter Swiss study, we aim at identifying biomarkers in the routine EEG and MRI with newly developed algorithms, thus facilitating the clinical decision for or against a particular treatment or further examinations.
In the SWISS FIRST trial, we will examine patients with MRI and EEG in the context of clinical data after a first probably unprovoked probable seizure, which could be the first sign of an epileptic disorder.
We will implement new strategies of EEG and MRI acquisition and analysis at the first event. A follow-up of two years will determine if the forecast was correct
We will further stratify whether categorization of the underlying syndrome (epileptic, cardiac, psychogenic, other) is possible after the first event