New Guidelines for Treatment of First Seizure

Epilepsy surgery
Epilepsy surgery
The guidelines encourage doctors to have a meaningful conversation with their patients to evaluate risks and benefits of treatment.

WASHINGTON — Taking epilepsy drugs immediately after a first seizure may reduce the risk of having another seizure, according to new seizure guidelines published by the American Academy of Neurology and the American Epilepsy Society.

Deciding how to address a first seizure is a complex decision, and with one in 10 people likely to experience a first seizure, the organizations came together to create more clear guidelines.

“This is a valuable new guideline that could change the approach many doctors take to treating a first seizure and could improve patients’ lives,” said guideline author Allan Krumholz, MD, of the University of Maryland. “This guideline clarifies when risk factors put individuals at greater risk.”

The guidelines, where were announced at the American Academy of Neurology 2015 Annual Meeting, show that for adults who have had  a first seizure, risk of another seizure is greatest within the first two years, with risk ranging from about 21% to 45%. Risk is greatest in those with a previous brain problem, including head injury, stroke, or brain tumor, and those with abnormal EEG test results.

Although there was moderate evidence that immediate treatment after first seizure can lower the risk of a second, longer-term data indicated that immediate treatment is unlikely to increase or decrease the likelihood of improvement or seizure freedom over time.

The decision to treat a first seizure with antiepileptic therapies does not come without risks, as side effects from drugs can affect the overall quality of life of patients. Although most adverse events are mild and reversible, the authors stressed that treatments plans and risk factors must be thoroughly assessed when deciding whether or not to start therapy.

“What is most important is that the decision whether to immediately treat a first seizure requires meaningful conversation between patient and doctor so that the patient’s individual circumstances, balance of risks and benefits, and personal preferences are understood and accounted for,” said study co-author Jacqueline French, MD, of New York University Langone Comprehensive Epilepsy Center.

The guideline, which was published in Neurology, was endorsed by the American Neurological Association and the World Federation of Neurology.


  1. AAN Press Release