Epilepsy Treatment Should Immediately Follow First Seizure

A guideline recently released by the American Academy of Neurology (AAN) and the American Epilepsy Society has clarified that antiepileptic medication should be administered immediately after a patient’s first seizure in order to reduce the risk of having another seizure within 2 years. The guideline, presented at the AAN’s 67th Annual Meeting and published in Neurology, is the first to address treatment of a first seizure in adults.

According to the guideline, adults who have had a first seizure face a 21% to 45% increased risk of another seizure in the 2 years following the incident. This risk is greatest among patients with a previous brain injury, such as a stroke, tumor, or head trauma, as well as in those with a significant abnormality on imaging tests of the brain. However, the guideline revealed that immediate treatment with an antiepileptic medication can lower the risk of another seizure by 35% within these first 2 years.

“Determining whether to treat a patient after a first seizure is a complex process, but this guideline supports the use of medication in some cases and could influence standard practice for many physicians,” said the guideline’s author, Allan Krumholz, MD, in a press release.

“A single seizure could be a sign of epilepsy. Even 1 seizure is traumatic and can affect many aspects of an individual’s life, from driving a car to employment options. This guideline clarifies when a person’s risk for another seizure warrants medication.”

The guideline stated that 7% to 31% of patients who are treated with antiepileptic medication will experience an adverse effect (AEs) related to the drug, but noted that these AEs are typically mild and can be reversed when the dose is lowered or when a patient is switched to a different medication. The guideline also acknowledged that although immediate antiepileptic treatment can yield a short-term benefit, it is unlikely to have a long-term effect on whether a patient remains seizure-free.