Group Issues New Guidelines for Treating First Seizures

A team of authors from various medical institutions has released new guidelines that recommend physicians discuss the appropriateness of prescribing medication to reduce risk of additional seizures following a first seizure.

According to the authors, which include physicians from the University of Maryland School of Medicine and NYU Langone Medical Center, adults who experience a first seizure may be at the greatest risk of incurring another within the first 2 years, while adults with prior neurological trauma, and abnormalities on EEGs and imaging may at higher risk.

Omega-3 Fish Oil Could Reduce Epileptic Seizure Frequency
New Definition Identifies Key Components of Epilepsy

The team found reasonable evidence that immediate treatment with an epilepsy drug can lower risk of recurrent seizures within 2 years of the first episode. However, they also determined that, after more than 3 years, immediate treatment with an epilepsy drug isn’t likely to improve the likelihood of avoiding another seizure, in comparison to waiting for another seizure before treating.

While noting that the guidelines don’t oblige patients to start taking medication immediately if presenting with a first seizure, they do seek to encourage physicians to engage in dialogue with patients concerning the risks and benefits of beginning treatment after suffering a first seizure, according to the authors.

More specifically, the guidelines state that clinicians should counsel patients with unprovoked first seizure that the risk for recurrent seizure is highest within the first 2 years (21% to 45%), and that factors such as previous brain injury, EEG with epileptiform abnormality, significant abnormalities on brain imaging, and nocturnal seizure increase the risk for treatment.

These recommendations “should be a valuable resource to primary care practitioners,” says Allan Krumholz, MD, a professor of neurology at the University of Maryland School of Medicine, and a co-author of the new guidelines, which also provide handouts from the American Academy of Neurology website, as well as videos that can be used to inform and educate patients “so they can share in this decision making process with their primary care or other providers.”

The issue of when to treat a first seizure is “not an easy one,” says Krumholz, “because the literature and studies are complicated. It is our hope that this guideline will be a useful tool for practitioners to use to determine the best options for their patients.”

It is “particularly important” for primary care practitioners and emergency room physicians to have this information, he adds, “because they often see these patient with a first seizure before the patient sees a neurologist, and are often the ones making this initial decision and providing recommendations in the days or weeks after a first seizure.”

—Mark McGraw


Krumholz A, Wiebe S, 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.