Chapter

Management of Patients with First Seizure and Early Epilepsy

Zachary Grinspan and Shlomo Shinnar

in Oxford Textbook of Epilepsy and Epileptic Seizures

Published on behalf of Oxford University Press

Published in print December 2012 | ISBN: 9780199659043
Published online December 2012 | e-ISBN: 9780191751363 | DOI: http://dx.doi.org/10.1093/med/9780199659043.003.0022

Series: Oxford Textbook of

Management of Patients with First Seizure and Early Epilepsy

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This chapter reviews the approach to the management of the patient with a single seizure or with early epilepsy. After a single unprovoked seizure, factors predicting recurrence include remote symptomatic etiology, abnormal EEG, or seizure while asleep. The data from randomized trials demonstrate that while treatment reduces recurrence risk, it does not alter long term prognosis. Furthermore, the group that presents with one seizure has a particularly favorable prognosis. Therefore, in the vast majority of cases, treatment with antiepileptic drugs is not necessary after a single seizure. For patients with two or more unprovoked seizures, treatment with antiepileptic drugs is usually initiated. Most patients with early epilepsy will respond to any of several appropriate drugs at modest doses. Therefore drug selection focuses on favorable adverse event profile rather than on mechanism. This profile needs to be individualized to the patient’s age, gender, and any comorbid diagnosis. The treatment decisions, choice of medication, topics for counselling, and prognosis for remission also require an understanding of each patient’s seizure types, epilepsy syndrome, and access to care. The majority of patients with early epilepsy will attain seizure remission.

Chapter.  7763 words. 

Subjects: Neurology

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