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. In this case, starting a seizure medicine is usually recommended.
  • A person who had been diagnosed with a partial seizure has most likely had other events too. Previous events probably were not seen or recognized as a seizure.
  • Usually it takes a more pronounced episode or convulsion to bring the person to the doctor. If a partial seizure has definitely occurred, many doctors recommend treatment because there is a high chance of having more seizures.
  • The question is more difficult for a single tonic-clonic (grand mal) seizure. The chance of another seizure can range 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 or tests. 
  • In general, 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 or MR scan) 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

Who makes the decision about taking medicine?

The doctor will recommend whether seizure medicine should be used or not, but the decision is not the doctor's alone.

  • Some people may be willing to take the risk of having another seizure before wanting to start therapy.
  • The choice will be based on the likelihood of more seizures, the patient's lifestyle, and the likely side effects of medicine. For example, the risks of a seizure in a person who drives, climbs heights, or works with small children should be thought about.
  • If a person has been taking medicine after having just one seizure but doesn’t have any others after a period of time, they should talk to their health care team to see if medicine can be stopped.

 

Authored by: Steven C. Schachter, MD | Patricia O. Shafer, RN, MN | Joseph I. Sirven, MD on 7/2013
Reviewed by: Joseph I. Sirven, MD | Patricia O. Shafer, RN, MN on 3/2014
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