What is the role of anticonvulsant therapy in the treatment of first adult seizure?

Updated: Nov 30, 2017
  • Author: Eissa Ibrahim AlEissa, MD, MBBS; Chief Editor: Selim R Benbadis, MD  more...
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Immediate anticonvulsant treatment reduces the likelihood of a second seizure by half. [9] According to a report by Chandra, valproate treatment reduced seizure recurrence rates from 63% to 4.3%. [44] However, immediate anticonvulsant therapy does not affect the long-term prognosis for achieving 1- or 2-year seizure-free remission and exposes many patients who would never have a recurrent seizure to anticonvulsant side effects. [24]

The general consensus is that anticonvulsant treatment is needed after 2 seizures. The decision to provide anticonvulsant treatment after 1 seizure should be individualized. Two situations that are often encountered in clinical practice and should be distinguished are a first seizure and new-onset epilepsy with more than 1 unprovoked seizure. Berg and Shinnar emphasized the need to distinguish between these 2 entities in clinical studies. [12]

Seizure recurrence risk is substantially higher after 2 or more unprovoked seizures than after just 1. [11]

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