Impact of the Occurrence While Sleeping of First Unprovoked Seizure on Seizure Recurrence: A Systematic Review

Abstract

Background and Purpose The impact of the occurrence while sleeping of first unprovoked seizure (FUS) on seizure recurrence in people with FUS is currently unclear. This un-certainty makes it challenging for physicians to determine whether to apply antiseizure medications (ASMs) to people with FUS while sleeping (FUS-S). This study aimed to determine the impact of the occurrence while sleeping of FUS. Methods We searched the MEDLINE, Embase, Cochrane Library, Web of Science, and Sco-pus electronic databases. Among retrieved studies, we selected those that provided information on the number of people with FUS, and relapsed people among these in each instance of FUS-S and FUS when waking (FUS-W). We used a random-effects model for meta-analyses. Results Of the 3,582 identified studies, 13 were eligible for systematic review. Seven of these 13 studies were deemed adequate for inclusion in a meta-analysis since they provided infor-mation at the time point of 2 years follow-up after FUS. The seven studies were of high quality regarding their risk of bias. When combining these 7 studies, the total sample comprised 1,659 people, of which 626 had FUS-S and 1,033 had FUS-W. The relative risk of seizure recurrence between FUS-S and FUS-W was 1.627. The seizure recurrence rates (SRRs) were 59.8% and 36.5% in the FUS-S and FUS-W groups, respectively. Conclusions We verified that the SRR was higher among people with FUS-S than FUS-W. After 2 years of follow-up, the SRR in people with FUS-S was about 60%. It is preferable to initiate an ASM for people with FUS-S. Systematic review registration PROSPERO registration number CRD42021266191.