CNS Drugs

, Volume 21, Issue 2, pp 89–99 | Cite as

Treatment Strategies After a Single Seizure

Rationale for Immediate versus Deferred Treatment
  • Laura C. Miller
  • Frank W. Drislane
Leading Article


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.


Epileptic Seizure Seizure Recurrence Unprovoked Seizure Early Seizure International League Against Epilepsy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



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.


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Copyright information

© Adis Data Information BV 2007

Authors and Affiliations

  • Laura C. Miller
    • 1
  • Frank W. Drislane
    • 1
  1. 1.Department of NeurologyBeth Israel Deaconess Medical CenterBostonUSA

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