Treatment Strategies After a Single Seizure
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What is the rationale for the treatment of an epileptic seizure? More specifically, should a first seizure be treated as soon as it is diagnosed or should one defer treatment until a second seizure occurs? Several studies indicate that the risk of a second (unprovoked) seizure is <50%, but studies vary in methodology and most have reviewed outcome in children only. Also, many patients were maintained on antiepileptic drugs (AEDs) during these studies, meaning that the risk for seizure recurrence was perhaps underestimated compared with the risk if untreated.
Most neurologists recommend waiting for a second seizure in order to avoid complications of medications that might prove to be unnecessary. Several large studies show that delaying treatment until a second seizure occurs does not worsen the course of epilepsy or likelihood of eventual seizure control. Seizures attributable to an acute illness (‘acute symptomatic’, provoked seizures) usually resolve with treatment of the underlying illness and thus long-term AEDs are often unwarranted. Nevertheless, seizures arising in certain circumstances are more likely to recur and there are special considerations for patients with strokes, tumours, infections and dementia, and also after head injury or neurosurgery.
Patient preferences with regard to risk and benefit also enter into the decision on whether to initiate AED treatment after a single seizure.
KeywordsEpileptic Seizure Seizure Recurrence Unprovoked Seizure Early Seizure International League Against Epilepsy
No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.
- 11.Stroink A, Brouwer OF, Arts WF, et al. The first unprovoked, untreated seizure in childhood: a hospital based study of the accuracy of the diagnosis, rate of recurrence, and long term outcome after recurrence. Dutch Study of Epilepsy in Childhood. J Neurol Neurosurg Psychiatry 1998; 64: 595–600Google Scholar
- 16.First Seizure Trial Group. Randomized clinical trial on the efficacy of antiepileptic drugs in reducing the risk of relapse after a first unprovoked tonic-clonic seizure. Neurology 1993; 3: 478–83Google Scholar
- 18.Marson A, Jacoby A, Johnson A, et al. Immediate versus deferred antiepileptic drug treatment for early epilepsy and single seizures: a randomized controlled trial. Medical Research Council MESS Study Group. Lancet 2005; 365: 2007–13Google Scholar
- 34.Matthew E, Sherwin AL, Welner SA, et al. Seizures following intracranial surgery: incidence in the first post-operative week. Can J Neurosci 1980; 7: 285–90Google Scholar
- 55.Schierhout G, Roberts I. Anti-epileptic drugs for preventing seizures following acute traumatic brain injury. Cochrane Database Syst Rev 2001; (4): CD 000173Google Scholar
- 61.Vélez L, Selwa LM. Seizure disorders in the elderly. Am Fam Physician 2003; 67: 323–32Google Scholar