Early Treatment of a Single Generalized Tonic-Clonic Seizure to Prevent Recurrence

Abstract

Treatment after a single unprovoked seizure leads to a significant reduction in the risk of relapse of generalized tonic-clonic epilepsy.

Evidence-Based Guideline: Management of an Unprovoked First Seizure in Adults: Report of the Guideline Development Subcommittee of the American Academy of Neurology and the American Epilepsy Society

“…Generalized tonic-clonic convulsive seizures comprise the major seizure type, with some studies including only patients with such seizures. 12,13,17,22 These studies, including both AED-treated and untreated subjects, demonstrate that the cumulative incidence of seizure recurrence increases over time, with the great majority of recurrences occurring within the first 1 to 2 years after the initial seizure and the greatest risk in the first year (i.e., 32% at 1 year, as compared with just 46% by 5 years) (table 1 and figures 1 and 2). Patient ascertainment and treatment differences among stud- ies may account for some of the wide variation in recurrence rates observed.…”

“…15 Details as to what constituted immediate AED treatment were not provided in the other Class II studies. 18,21,22 Despite this reduced risk of early seizure recurrence, the only quality of life (QOL) analysis, which is from a Class II study, demonstrates no significant differences in standard, validated 2-year QOL measures. 15,26 Conclusion.…”

Evidence-based guideline: Management of an unprovoked first seizure in adults

“…Tables e-1 Evidence. We identified 2 prognostic Class I [10][11][12][13][14] and 8 prognostic Class II studies [15][16][17][18][19][20][21][22] addressing the probability that an adult with an unprovoked first seizure would have recurrent seizures, and estimated the recurrence risk from these pooled data, which included studies wherein AED treatment was not randomized or controlled (table 1, figure 1). Generalized tonic-clonic convulsive seizures comprise the major seizure type, with some studies including only patients with such seizures.…”

“…Evidence. We identified 1 Class I study [12][13][14] and 4 Class II studies 15,18,21,22,26 addressing this issue (table 2). Immediate therapy with an AED after an unprovoked first seizure in adults significantly reduces seizure risk in the short term, which we define as within 2 years (figure 1).…”

Electroencephalogram and first episode afebrile seizure in children

“…19 Finally, in randomized trials, Gilad et al found no correlation between EEG abnormalities and seizure recurrence risk. 20 Das et al found that EEG abnormalities were predictive of subsequent seizures (p<0.001). 21 Wiebe et al in their article titled an evidence-based approach to the first seizure concluded from their review: retrospective, prospective, and randomized controlled studies in children and adults provide good evidence that early seizure recurrence is reduced by early initiation of AED treatment.…”