Guidelines for Treating First Seizure

Guidelines for Treating First Seizure

According to current estimates, about 150,000 American adults present with an unprovoked first seizure each year. Studies show that even one seizure can be a traumatic physical and psychological event for patients. They can have major consequences for patients, including loss of driving privileges, employment limitations, a higher risk for falls, and fears of having another seizure in public. Recurrent seizures can be even more serious and costly. Unprovoked first seizures are difficult to for clinicians to diagnose and treat. In 2007, practice guidelines were released to help clinicians evaluate an unprovoked first seizure in adults. In 2015, the American Academy of Neurology and the American Epilepsy Society issued evidence-based guidelines on prognosis and therapy for first seizures. This guideline, published in Neurology and available for free at, clarifies when risk factors put individuals at greater risk for seizure recurrence. Prevention of seizure recurrence with antiepileptic drug (AED) therapy is also discussed. “Evidence-based approaches are needed to evaluate and manage adults after a first seizure,” says Allan Krumholz, MD, who was lead author of the guideline. “This guideline is a valuable tool because it could change approaches to treating first seizures, enabling clinicians to possibly improve outcomes and quality of life in patients.” Conveying Recurrence Risk The guidelines offer recommendations regarding the risk of seizure recurrence among patients who have an unprovoked first seizure. “Adults who have an unprovoked first seizure should be informed that their seizure recurrence risk is greatest early within the first 2 years,” Dr. Krumholz says. Studies show that recurrence risks vary between 21% and 45%, depending on a variety of factors (Figure). Several...

Adding Surgery to Medication Benefits Temporal Lobe Epilepsy

When compared with antiepileptic drug (AED) therapy alone, using respective surgery plus AED therapy appears to result in a lower probability of seizures after 2 years follow-up in patients with newly intractable, disabling mesial temporal lobe epilepsy. Results from a small study indicated that 73% of patients who received AED therapy plus surgery were seizure free at 2 years, compared with a 0% rate for patients who received only AED therapy. Abstract: JAMA, March 7,...