The Argument for a More Patient Attitude Toward a Single Unprovoked Seizure

Do Not Sleep on It! Prognosis of First-Ever Unprovoked Seizure From Sleep

“…Those with the first seizure from sleep were at a lower risk of having an injury from recurrences, and recurrences were more likely to occur from sleep. These observations support considering a conservative approach before initiating ASM therapy in patients after their first-ever seizure, 4 even so for those with their first seizure from sleep.…”

“…3 However, the decision to diagnose epilepsy or initiate anti-seizure medication (ASM) therapy following a single unprovoked seizure can be complex since it can be affected by several factors beyond these risk factors (Figure 1). 4 The AAN guideline recommendation regarding sleep as a risk factor for recurrence comes from 2 prior older studies. These studies looked at nocturnal seizures, defined as seizures occurring between midnight and 9 AM rather than seizures from sleep.…”

“…3 However, the decision to diagnose epilepsy or initiate anti-seizure medication (ASM) therapy following a single unprovoked seizure can be complex since it can be affected by several factors beyond these risk factors (Figure 1). 4…”

“… Factors potentially impacting decisions in patients with first-ever unprovoked seizure. Modified and used with permission from Feyissa and Cascino 4 with permission of Elsevier, all rights reserved. EEG indicates electroencephalogram; MRI, magnetic resonance imaging; SUDEP, sudden unexpected death in epilepsy.…”