How is the risk of recurrence of epileptic seizures managed in patients with one abnormality?

Updated: May 30, 2019
  • Author: David Y Ko, MD; Chief Editor: Selim R Benbadis, MD  more...
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Answer

The major unresolved question is how to treat patients with 1 abnormality, whose recurrence risk is 30-50%. One approach is to base the decision on a discussion with the patient that includes the risk of seizure recurrence, the risk of toxic effects from the anticonvulsant, and the benefits of avoiding another seizure. The clinician should also describe seizure precautions, including not driving for a specific time. Treatment with anticonvulsants does not alter the natural history of seizure recurrence; it only reduces the risk for the duration of treatment.

The First Seizure Trial Group randomly selected 397 patients with an unprovoked, generalized tonic-clonic first seizure to either receive prophylaxis with a conventional anticonvulsant (ie, carbamazepine, phenobarbital, phenytoin, valproic acid) or to receive no treatment and reported that about 18% of treated patients had seizure recurrence within 1 year, compared with 39% of untreated patients. [33] Therefore, patients must be told that anticonvulsants can reduce their risk of having another seizure but will not eliminate that risk.


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