Should first seizures be treated with a seizure medicine?

The answer depends on the type of seizure. As a rule, when a single absence seizure is reported and confirmed by the typical electroencephalogram (EEG) pattern, the child usually has had many other staring spells that have not been noticed, so treatment is usually recommended. Similarly, with partial seizures, a person may commonly have had several partial seizures, but one relatively prominent episode or convulsion has finally brought him or her to the doctor. If a partial seizure has definitely occurred, many doctors recommend treatment because there is a high probability of more seizures.

The question is more difficult for a single tonic-clonic (grand mal) seizure. The chance of another seizure varies from 16% to 61%, depending on the circumstances surrounding the seizure and on whether the doctor finds anything abnormal on the patient's neurological exam, EEG, or tests like a CT scan or MRI. Another seizure may be unlikely and treatment with seizure medicine may not be recommended if:

• The results of a neurological examination and neuroimaging studies (CT scan, MRI) are normal
• The EEG is normal
• Factors that tend to provoke seizures, such as sleep deprivation or excessive alcohol intake, can be eliminated
• The seizure occurred during sleep
• There is no family history of epilepsy

The doctor probably will recommend whether seizure medicine should be used or not, but the decision is not the doctor's alone. Some patients may be willing to take the risk of having another seizure before agreeing to start therapy. The choice will be based on the likelihood of more seizures, the patient's lifestyle (for example, another seizure could be disastrous if the patient must drive a lot or cares for small children), and the likely side effects of the medicine.

If no more seizures have occurred after a certain amount of time, the possibility of stopping medication may be discussed.

Topic Editor: Steven C. Schachter, M.D.
Last Reviewed:12/15/06