General Approach To The Initial Seizure

Approximately 6 percent of the population experiences an afebrile seizure at least once in their lifetime. '10' The decision to initiate antiepileptic drug (AED) therapy after a single seizure is based on the risk of recurrence versus that of treatment. Nearly 30 percent of treated patients experience unacceptable side effects requiring discontinuation of anticonvulsant medication. 'i;' In addition, although the initiation of aEd therapy significantly reduces the risk of recurrence, it does not guarantee remission. Recurrence rates after single unprovoked seizures range from 27 to 71 percent. ';0 The most reliable predictors of recurrence are (1) evidence of a neurological abnormality based on known etiology, neurological examination, or neuroimaging studies; (2) epileptiform abnormalities on EEG; and (3) partial


versus generalized seizures. The risk of recurrence increases with the number of abnormalities identified.

Patients who experience their first seizure should be evaluated with an EEG and a magnetic resonance imaging (MRI) study. The need for laboratory studies, toxicological screens, and cerebrospinal fluid analysis should be determined on an individual basis. Seizures due to drugs, alcohol, and metabolic disturbances require treatment of the underlying cause instead of AED therapy. Patients with evidence of neurological abnormalities that are likely to persist should be treated with anticonvulsants after discussing the potential risks and benefits. Treatment is generally continued for a period of 1 to 2 years, after which medication is gradually withdrawn if seizures have not recurred. Approximately 80 percent of recurrences appear within 2 years, and the majority do so within 6 months. ';p| As a result, most states have laws requiring that driving be restricted for periods ranging from 3 to 12 months after a single unprovoked seizure. Individual state laws vary, as do the requirements for the reporting of patients to state authorities by physicians.


The Prevention and Treatment of Headaches

The Prevention and Treatment of Headaches

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