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Antiepileptic Drugs After First Unprovoked Seizure


Am Fam Physician. 2017 Feb 1;95(3):online.


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1 in 10 did not have a seizure recurrence within five years

1 in 10 had an adverse event

No deaths were prevented



1 in 10 did not have a seizure recurrence within five years

1 in 10 had an adverse event

No deaths were prevented

Details for This Review

Study Population: Patients of any age with any type of first unprovoked seizure1

Efficacy End Points: Seizure recurrence; seizure remission; mortality

Harm End Points: Tiredness or drowsiness; gastrointestinal symptoms; depression or anxiety; dizziness or unsteadiness; headache; injury

Narrative: The incidence of single unprovoked seizures ranges from 23 to 61 per 100,000 person-years2 and affects approximately 4% of the population by 80 years of age.3 The incidence of another unprovoked seizure after an initial seizure ranges from 30% to 50%3,4 and would categorize a patient as epileptic. Prescribing an antiepileptic drug after an initial unprovoked seizure might lower the probability of a recurrent seizure; however, these drugs are not curative and have potential complications,3 making the decision to start an antiepileptic drug after a first unprovoked seizure clinically challenging.

This summary discusses the benefits and harms of starting patients on antiepileptic drugs following an initial unprovoked seizure.1 Six studies totaling 1,634 participants (two studies with adults only, one with children only, and three with adults and children) were included in this review, and the follow-up period ranged from nine months to 16 years. Patients in these studies were randomized to immediate treatment with a first-generation antiepileptic drug, placebo, deferred treatment, or no treatment.

Two studies of 1,212 participants reported on the primary outcome of seizure recurrence within five years after initiation of an antiepileptic drug immediately following an unprovoked seizure. Participants randomized to immediate treatment had a statistically significantly lower probability of repeat seizure at five years (relative risk [RR]

Author disclosure: No relevant financial affiliations.


show all references

1. Leone MA, Giussani G, Nolan SJ, Marson AG, Beghi E. Immediate antiepileptic drug treatment, versus placebo, deferred, or no treatment for first unprovoked seizure. Cochrane Database Syst Rev. 2016;(5):CD007144....

2. Hauser WA, Beghi E. First seizure definitions and worldwide incidence and mortality. Epilepsia. 2008;49(suppl 1):8–12.

3. Herman ST. Single unprovoked seizures. Curr Treat Options Neurol. 2004;6(3):243–255.

4. Haut SR, Shinnar S. Considerations in the treatment of a first unprovoked seizure. Semin Neurol. 2008;28(3):289–296.

5. Wiebe S, Téllez-Zenteno JF, Shapiro M. An evidence-based approach to the first seizure. Epilepsia. 2008;49(suppl 1):50–57.

6. 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(16):1705–1713.



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