Initiation of antiepileptic drugs (AEDs) immediately after a first seizure reduces the risk of having another seizure, according to new guidelines published by the American Academy of Neurology and the American Epilepsy Society in the April 21 issue of Neurology. 

Epilepsy is defined as one or more seizures with a high likelihood of recurrence, not due to another immediately triggering cause, such as low blood sugar, according to the International League Against Epilepsy. On reviewing all the available evidence, lead author Allan Krumholz, MD, and colleagues found moderate evidence that immediate treatment with an epilepsy drug after a first seizure can lower the risk of subsequent seizures. However, they found moderate evidence that immediate treatment with an epilepsy drug for more than three years does not affect long-term improvement or remission. The authors found that epilepsy drugs carry risks of side effects ranging from 7% to 31%. 

The risk of another seizure among adults who have had a first seizure is greatest within the first two years (21%-45%). The analysis also found that clinical factors that are associated with an increased risk of more seizures include a prior condition involving the brain such as stroke, trauma, electroencephalogram (EEG) with epileptiform abnormalities, significant brain-imaging abnormality, or nocturnal seizure. The panel’s review determined that there was moderate evidence that the risk is greatest in people with a significant abnormality on imaging tests of the brain and in those who had a nocturnal seizure.

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