Should Single Epileptic Seizures Be Treated?

Abstract

Seizures are very frightening events. Nearly one in every ten individuals will have a seizure sometime during his or her life, but many of them will never have another attack. Seizures are sufficiently dramatic and unsettling that most patients are brought to medical attention and many ultimately come to neurologists for advice. Since one seizure does not make a patient an epileptic, should doctors always wait for a second attack before treating with anticonvulsants? Alternatively, since the recurrence rate is quite high, and some believe that seizures may damage the brain, treatment of all patients with a single seizure has been advocated. But if so, for how long? Is it appropriate to treat some patients and not others, and if so what should be the criteria for treatment? I asked three experienced epilepsy experts to respond to the issue of treating a single seizure. These consultants are Dr. J.W.A.S. Sander, from the National Hospital-Chalfont Centre for epilepsy and the Institute of Neurology, London, Dr. E.B. Bromfield, the director of the epilepsy program at the Brigham and Women’s Hospital, Harvard University, Boston, and Dr. I.E. Leppik of the Minnesota Comprehensive Research Center and the Epilepsy Research Program at the University of Minnesota in Minneapolis.