Beretta S, et al. – The physicians performed this study to investigate the long–term applicability of the new International League Against Epilepsy (ILAE) definition of epilepsy. In clinical practice, they supported the applicability of the new epilepsy definition. After a single unprovoked seizure, individual patient characteristics, and a personalized diagnostic approach could justify treatment.

• The physicians retrospectively recruited patients with newly diagnosed epilepsy with a minimum follow-up of 10 years.
• They stratified patients in 2 groups depending on the occurrence of one (new definition, ND) or two or more unprovoked seizures (traditional definition, TD) at the time of epilepsy diagnosis and compared for disease characteristics and factors predicting seizure recurrence.
• The occurrence of a new unprovoked seizure during follow-up in the ND group was the primary outcome.
• The achievement of an early remission in both groups was the secondary outcome.

• 152 patients (15.1%) were diagnosed after a single seizure among 1,006 patients with newly diagnosed epilepsy.
• Patients diagnosed according to the ND compared to patients diagnosed using the TD demonstrated a higher proportion of subjects with an abnormal neurologic examination (19.9% vs. 13.7%, p = 0.0504) and with focal seizures (69.3% vs. 60.4%, p = 0.0021).
• The two samples differed in the presence of at least 1 of the factors predicting seizure recurrence (focal seizures or abnormal findings in at least 1 among the following: neurologic examination, electroencephalography [EEG], and neuroimaging) (94.6% vs. 89.1%, p = 0.0376).
• At 10 years, long-term recurrence in patients diagnosed with the new definition was 83.6% and 89.1% at 15 years.
• Between the two groups, the probability of early remission did not differ.