AllanKrumholz, Director, US Department of Veterans Affairs Maryland Healthcare System Epilepsy Center of Excellenceguidelines@aan.com
Allan Krumholz, Baltimore, MD; Shlomo Shinnar, Bronx, NY; Jacqueline French, New York, NY; Samuel Wiebe, Calgary, Alberta, Canada; David Gloss, Danville, PA
Submitted June 03, 2015
We appreciate the comments from Lattanzi et al. regarding our practice guideline on management of a first seizure in adults. [1] As the WriteClick letter points out, and we agree, that sleep deprivation is indeed a potential seizure trigger but one that could recur. Such a triggered seizure is generally regarded as an "unprovoked" rather than a "provoked" seizure, which also coincides with its reported relative risk of recurrence, outlined in the helpful reference provided by Lattanzi et al. [2] We also concur that clinical judgment considering such specific factors is important in determining and stratifying individualized risks for seizure recurrence after a first unprovoked seizure, to guide management recommendations and decisions. Our guideline stresses that the choice to treat or not to treat with antiepileptic drugs should be based on assessment of such individualized risk and benefit by the clinician and the patient. [1] The approach recommended by Lattanzi et al. certainly falls within the decision-making parameters suggested by the guideline, although the actual determination in a given patient also may depend on other factors, as stated in our guideline.[1]
1. Krumholz A, Wiebe S, Gronseth GS, et al. 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. Neurology 2015;84:1705-1713.
2. Lawn N, Lieblich S, Lee J, Dunne J. Are seizures in the setting of sleep deprivation provoked? Epilepsy Behav 2014;33:122-125.
For disclosures, please contact the editorial office at journal@neurology.org.
We appreciate the comments from Lattanzi et al. regarding our practice guideline on management of a first seizure in adults. [1] As the WriteClick letter points out, and we agree, that sleep deprivation is indeed a potential seizure trigger but one that could recur. Such a triggered seizure is generally regarded as an "unprovoked" rather than a "provoked" seizure, which also coincides with its reported relative risk of recurrence, outlined in the helpful reference provided by Lattanzi et al. [2] We also concur that clinical judgment considering such specific factors is important in determining and stratifying individualized risks for seizure recurrence after a first unprovoked seizure, to guide management recommendations and decisions. Our guideline stresses that the choice to treat or not to treat with antiepileptic drugs should be based on assessment of such individualized risk and benefit by the clinician and the patient. [1] The approach recommended by Lattanzi et al. certainly falls within the decision-making parameters suggested by the guideline, although the actual determination in a given patient also may depend on other factors, as stated in our guideline.[1]
1. Krumholz A, Wiebe S, Gronseth GS, et al. 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. Neurology 2015;84:1705-1713.
2. Lawn N, Lieblich S, Lee J, Dunne J. Are seizures in the setting of sleep deprivation provoked? Epilepsy Behav 2014;33:122-125.
For disclosures, please contact the editorial office at journal@neurology.org.