AUTHOR=Habermehl Lena , Linka Louise , Krause Kristin , Fuchs Alena , Weil Jenny , Gurschi Mariana , Zahnert Felix , Möller Leona , Menzler Katja , Knake Susanne 

TITLE=The impact of the new definition of epilepsy on diagnosis, treatment, and short-term outcomes—A prospective study

JOURNAL=Frontiers in Neurology

VOLUME=Volume 16 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2025.1564680

DOI=10.3389/fneur.2025.1564680

ISSN=1664-2295

ABSTRACT=BackgroundIn 2014, the ILAE introduced a new definition of epilepsy that allows some patients to be diagnosed earlier than under the previously used definition. According to the old classification, the diagnosis was made after a second unprovoked seizure. The risk of this was 36% after the first seizure. The aim of this study is to investigate the clinical impact of the new definition on diagnosis, treatment, and short-term outcome.MethodsFrom 2018 to 2021, adult patients admitted with a first epileptic seizure were prospectively included. Demographic and clinical data were collected at baseline, at 6 and 12 months follow-up (FU). Factors affecting seizure recurrence, especially age, use of anti-seizure medication (ASM), interictal epileptiform discharges (IED) in the EEG, and the presence of structural lesions on imaging were investigated.ResultsData from 235 patients were collected (41.7% female). Of these, 146 patients (62.1%) were diagnosed with epilepsy (PWE), following the new ILAE-criteria. Potential epileptogenic lesions on imaging were found in 49.3% of PWE. At the first FU (6.08 months ± 1.35), 143 patients (77.3%) were seizure-free, including 89 of the 146 patients diagnosed as PWE were seizure-free (70.6%). At the second FU (12.45 months ± 1.83), 129 patients (80.6%) were seizure-free. Seventy-seven of the PWE were seizure-free (72%). The use of ASM decreased (odds ratio = 0.46, p = 0.004) the recurrence rate significantly.ConclusionOur results suggest that the new definition of epilepsy results in a higher frequency of epilepsy diagnosis and treatment. Short-term outcomes improved (1-year-recurrence rate of 19.4%).