RT Journal Article SR Electronic T1 Evidence-based guideline: Management of an unprovoked first seizure in adults JF Neurology JO Neurology FD Lippincott Williams & Wilkins SP 1705 OP 1713 DO 10.1212/WNL.0000000000001487 VO 84 IS 16 A1 Krumholz, Allan A1 Wiebe, Samuel A1 Gronseth, Gary S. A1 Gloss, David S. A1 Sanchez, Ana M. A1 Kabir, Arif A. A1 Liferidge, Aisha T. A1 Martello, Justin P. A1 Kanner, Andres M. A1 Shinnar, Shlomo A1 Hopp, Jennifer L. A1 French, Jacqueline A. YR 2015 UL http://n.neurology.org/content/84/16/1705.abstract AB Objective: To provide evidence-based recommendations for treatment of adults with an unprovoked first seizure.Methods: We defined relevant questions and systematically reviewed published studies according to the American Academy of Neurology's classification of evidence criteria; we based recommendations on evidence level.Results and recommendations: Adults with an unprovoked first seizure should be informed that their seizure recurrence risk is greatest early within the first 2 years (21%–45%) (Level A), and clinical variables associated with increased risk may include a prior brain insult (Level A), an EEG with epileptiform abnormalities (Level A), a significant brain-imaging abnormality (Level B), and a nocturnal seizure (Level B). Immediate antiepileptic drug (AED) therapy, as compared with delay of treatment pending a second seizure, is likely to reduce recurrence risk within the first 2 years (Level B) but may not improve quality of life (Level C). Over a longer term (>3 years), immediate AED treatment is unlikely to improve prognosis as measured by sustained seizure remission (Level B). Patients should be advised that risk of AED adverse events (AEs) may range from 7% to 31% (Level B) and that these AEs are likely predominantly mild and reversible. Clinicians' recommendations whether to initiate immediate AED treatment after a first seizure should be based on individualized assessments that weigh the risk of recurrence against the AEs of AED therapy, consider educated patient preferences, and advise that immediate treatment will not improve the long-term prognosis for seizure remission but will reduce seizure risk over the subsequent 2 years.AAN=American Academy of Neurology; AE=adverse event; AED=antiepileptic drug; CI=confidence interval; ILAE=International League Against Epilepsy; QOL=quality of life