Do first-time seizures need to be treated?
A first seizure is very frightening. Questions arise about the cause of the seizure, the chance of recurrence, dangers of another seizure, the need for a seizure medicine, and the possibility of lifelong medication. In the vast majority of cases, epilepsy does not result from a life-threatening disorder such as a brain tumor.
Not all first-time seizures need to be treated with medication. Close to 9 percent of the population will have at least one seizure during their lifetime, but only 1 person out of 100 to 200 will develop recurrent seizures. Factors that influence the chance of recurrence and the decision to treat include the type of seizure and whether it occurred during the day or at night. The results of the diagnostic tests (neurologic exam, EEG, and neuroimaging studies like the MRI) will influence treatment. So will the person's family history—have relatives had seizure disorders? More serious seizures during wakefulness and abnormalities on tests suggest a greater need for treatment.
If provocative factors were present when the seizure occurred, medication may not be needed. Such factors include:
- sleep deprivation
- alcohol consumption
- high fever
Of course, the person would do well to try to reduce or eliminate the factor in the future.
Lifestyle factors will also influence the decision about treatment. A mother caring for two small children at home might be treated with seizure medicines, but a college student living on campus who promises to limit alcohol intake might not be treated.
Side effects from medications can also influence the decision. For instance, a teacher began medication after one seizure following sleep deprivation. He developed problems with concentration when taking the medication, so the medication was discontinued and he promised to be more careful to get adequate sleep instead.
There is no simple answer as to whether to treat or not to treat a single tonic-clonic seizure. The decision is based on a consideration of all relevant factors and an open discussion between the doctor and patient (or the parents, if the patient is a child). If seizure medicine is started, most doctors recommend that after a year or two seizure-free, the medication should be discontinued gradually.