The American Academy of Neurology (AAN) and the American Epilepsy Society have released a new guideline for clinicians on treating patients who experience their first seizure, which will be presented at the AAN’s 67th Annual Meeting in Washington, D.C.

Because the risks and benefits of treatment after a first seizure are complicated, all available evidence was reviewed in preparation for the guideline. The results were divided according to strong and moderate evidence:

Strong Evidence

  • Risk of a second seizure is greatest within the first two years for adults who have had a first seizure, ranging from about 20–45%.
  • Risk of a second seizure is greatest in individuals with a previous brain problem, such as head injury, stroke, or brain tumor and in those with an EEG test result that shows signs of epilepsy.

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Moderate Evidence

  • Risk of a second seizure is greatest in those with a significant abnormality on imaging tests of the brain and in those who had a seizure during sleep.
  • Immediate treatment with an epilepsy drug, rather than waiting for another seizure before treatment, is unlikely to increase or decrease the likelihood of long-term improvement or seizure freedom over the longer term of more than three years.

Due to the benefits and risks associated with epilepsy medications, the guideline can assist clinicians in decisions regarding individualized treatment for patients after their first seizure.

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