Last updated December 18, 2021

Management Of An Unprovoked First Seizure In Adults

Recommendations

Adults with an unprovoked first seizure should be informed
  • that their seizure recurrence risk is greatest early within the first 2 years (21%–45%),
(A)
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  • and clinical variables associated with increased risk may include a prior brain insult,
(A)
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  • an EEG with epileptiform abnormalities
(A)
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  • a significant brain-imaging abnormality
(B)
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  • and a nocturnal seizure.
(B)
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Immediate antiepileptic drug (AED) therapy, as compared with delay of treatment pending a second seizure,
  • is likely to reduce recurrence risk within the first 2 years
(B)
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  • but may not improve quality of life.
(C)
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Over a longer term (>3 years), immediate AED treatment is unlikely to improve prognosis as measured by sustained seizure remission. (B)
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Patients should be advised that risk of AED adverse events (AEs) may range from 7% to 31% and that these AEs are likely predominantly mild and reversible. (B)
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Clinicians' recommendations whether to initiate immediate AED treatment after a first seizure should be based on individualized assessments that weigh the risk of recurrence against the AEs of AED therapy, consider educated patient preferences, and advise that immediate treatment will not improve the long-term prognosis for seizure remission but will reduce seizure risk over the subsequent 2 years. ()
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Recommendation Grading

Overview

Title

Management Of An Unprovoked First Seizure In Adults

Authoring Organization

Endorsing Organizations

Publication Month/Year

April 21, 2015

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Male, Adult, Older adult

Health Care Settings

Ambulatory, Emergency care, Home health, Hospital, Long term care, Outpatient

Scope

Assessment and screening, Diagnosis, Management, Treatment

Diseases/Conditions (MeSH)

D012640 - Seizures

Keywords

seizure, adult seizure, unprovoked first seizure

Source Citation

Allan Krumholz, et al. Management Of An Unprovoked First Seizure In Adults. Neurology. 2015; 84(16): 1705-1713.