Evidence-based guideline

Management of an unprovoked first seizure in adults

Allan Krumholz, Samuel Wiebe, Gary S. Gronseth, David S. Gloss, Ana M. Sanchez, Arif A. Kabir, Aisha T. Liferidge, Justin P. Martello, Andres M Kanner, Shlomo Shinnar, Jennifer L. Hopp, Jacqueline A. French

Research output: Contribution to journalArticle

88 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1705-1713
Number of pages9
JournalNeurology
Volume84
Issue number16
DOIs
StatePublished - Apr 21 2015

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Seizures
Guidelines
Anticonvulsants
Recurrence
Therapeutics
Drug Therapy
Patient Preference
Neurology
Neuroimaging
Electroencephalography
Quality of Life
Brain

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Krumholz, A., Wiebe, S., Gronseth, G. S., Gloss, D. S., Sanchez, A. M., Kabir, A. A., ... French, J. A. (2015). Evidence-based guideline: Management of an unprovoked first seizure in adults. Neurology, 84(16), 1705-1713. https://doi.org/10.1212/WNL.0000000000001487

Evidence-based guideline : Management of an unprovoked first seizure in adults. / Krumholz, Allan; Wiebe, Samuel; Gronseth, Gary S.; Gloss, David S.; Sanchez, Ana M.; Kabir, Arif A.; Liferidge, Aisha T.; Martello, Justin P.; Kanner, Andres M; Shinnar, Shlomo; Hopp, Jennifer L.; French, Jacqueline A.

In: Neurology, Vol. 84, No. 16, 21.04.2015, p. 1705-1713.

Research output: Contribution to journalArticle

Krumholz, A, Wiebe, S, Gronseth, GS, Gloss, DS, Sanchez, AM, Kabir, AA, Liferidge, AT, Martello, JP, Kanner, AM, Shinnar, S, Hopp, JL & French, JA 2015, 'Evidence-based guideline: Management of an unprovoked first seizure in adults', Neurology, vol. 84, no. 16, pp. 1705-1713. https://doi.org/10.1212/WNL.0000000000001487
Krumholz A, Wiebe S, Gronseth GS, Gloss DS, Sanchez AM, Kabir AA et al. Evidence-based guideline: Management of an unprovoked first seizure in adults. Neurology. 2015 Apr 21;84(16):1705-1713. https://doi.org/10.1212/WNL.0000000000001487
Krumholz, Allan ; Wiebe, Samuel ; Gronseth, Gary S. ; Gloss, David S. ; Sanchez, Ana M. ; Kabir, Arif A. ; Liferidge, Aisha T. ; Martello, Justin P. ; Kanner, Andres M ; Shinnar, Shlomo ; Hopp, Jennifer L. ; French, Jacqueline A. / Evidence-based guideline : Management of an unprovoked first seizure in adults. In: Neurology. 2015 ; Vol. 84, No. 16. pp. 1705-1713.
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