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