First seizure in an adult: To treat or not
BY JENNIE SMITH
In 2014, the International League Against Epilepsy redefined who could be considered to have epilepsy. An adult with only a single seizure – previously the threshold was two seizures at least 24 hours apart – could be considered to have epilepsy if the seizure lacked an immediate triggering cause such as trauma or metabolic disturbance, and the clinician deemed the person at risk of further seizures based on imaging or EEG results, or clinical factors. Patients at 60% or greater risk for a second seizure over the next 10 years could be considered to have epilepsy. In redefining the clinical definition of epilepsy, ILAE also unpegged disease and treatment: the presence of disease does not mandate treatment and the ab-sence of disease does not preclude treatment, the organization said (Epilepsia 2014 55(4):475-82. doi: 10.1111/epi.12550). That opened the door to many more people being treated with anti-epileptic drugs. In 2015, the American Academy of Neurology and American Epilepsy Society issued a guideline focused on adults with first seizures, citing evidence that initiating AEDs immediately – without waiting for a second seizure to occur – reduced the person’s risk of new seizures by about 35% in the two years that followed, a period when risk of recurrence is highest (Neurology April 2015; 84[16]). But the decision on whether to start the drugs had to be made carefully, the guidelines stressed, in collaboration with the patient, who would need to be advised that AED treatment could compromise quality of life, and that long-term prognosis would not necessarily be improved as a result of AED treatment. |
|
|