First seizure - to treat or not to treat?

BACKGROUND

The decision on whether or not to treat a first seizure is dependent on several medical and non-medical factors.

AIMS

In this review, we have summarised the important aspects that determine the advantages and disadvantages of treating a first seizure. We have looked at evidence from randomised controlled trials and key observational studies.

CONCLUSIONS

There is no randomised controlled evidence that treating the aetiology of a first acute symptomatic seizure reduces the risk of relapse, although there are good biological arguments for this. For first unprovoked seizures, immediate treatment reduces the risk of seizure recurrence in the short term, but does not change the long-term prognosis for epilepsy. Other important considerations include the potential adverse events of antiepileptic drugs and socioeconomic factor such as lifestyle changes, driving, employment, financial implications and relationships. Treatment decisions can be made only on an individual patient basis after weighing the pros and cons of each case separately.