The American Academy of Neurology and the American Epilepsy Society’s joint evidence-based guideline for the management of an unprovoked first seizure in adults includes the following recommendations:
• Inform patients that the seizure recurrence risk is greatest in the first 2 years (21% to 45%), and factors that may increase risk include a prior brain insult, an EEG with epileptiform abnormalities, a significant brain-imaging abnormality, and a nocturnal seizure.
• Starting an antiepileptic drug (AED) immediately, rather than waiting for a second seizure, is likely to reduce the 2-year recurrence risk, but is unlikely to improve prognosis over the longer term (3 years or more) as measured by sustained seizure remission.
• Inform patients the risk of adverse events with AEDs range from 7% to 31%, and are typically mild and reversible.
• Base therapy recommendations on individualized assessments that weigh the risk of recurrence against the adverse effects of medication, patient preferences, and the understanding that AED treatment will help in the short term but not the long term.
Citation: Krumholz A, Wiebe S, Gronseth GS, et al. Evidence-based guideline: management of an unprovoked first seizure in adults: report of the Guideline Development Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. 2015;84(16):1705-1713.