Rethinking Seizure Care Blog

After the First Seizure: To Treat or Not to Treat?

Posted by RSC Diagnostics on Jan 9, 2020

Vet writing on clipboard the prescriptions in medical office

Many people wonder whether they should start taking an anti-epilepsy drug (AED) after they experience their first seizure.

The Epilepsy Foundation estimates that 1 in 26 people will develop seizures at some point in their life. Statistically, if a patient has experienced a first seizure, the likelihood of them experiencing a second is 30% to 50%. The likelihood of experiencing a third seizure jumps to 70% to 80%. If you have had your first seizure, you will likely have a lot of questions. 

When weighing whether to start the patient on AEDs, the doctor will consider the type of seizure and the circumstances under which the seizure occurred as these play a pivotal role in the decision-making process. Sometimes a seizure may be triggered by extreme circumstances, such as heat stroke or sleep deprivation. When a patient reports a first-time seizure, the physician will try to determine whether it is something other than epilepsy. Seizures can occur from a head injury, an infection, or a reaction to alcohol or some other drug so eliminating or identifying any of them as a cause is an important step.

When to Treat with Medications

If the physician can assess the external trigger, (e.g. alcohol or drugs) then the patient will be told to avoid the trigger and no medication will be given. AED medications are not normally ordered unless the patient has had more than one seizure or a test indicates the patient is at high risk.

What Might Testing Reveal?

If the MRI (magnetic resonance imaging), EEG (electroencephalography), or CAT/CT scan (computed axial tomography) suggests the patient is at risk, the physician will order medications to prevent another occurrence.

However, AED medication may be started after the first seizure if any of these are conditions are true.

  • When a child experiences a seizure that is characterized by staring off into space and “zoning out.” If an EEG or another test proves this is not the first incidence, but rather the first seizure witnessed, then the physician will prescribe anti-seizure medication to prevent future episodes.
  • If the doctor concludes that a patient has experienced partial seizures in the past, medication will be prescribed to prevent further seizures.
  • If the seizure is a single tonic-clonic “grand mal” seizure then the likelihood of another occurrence can range from 16% to 61. Due to this wide range, the physician will need to make a judgment call.

Can Medication Prevent a Second Seizure?

A study published in “Neurology” in April 2015, reported that patients who experienced a first-time seizure and were placed on AED medication showed a decreased risk in encountering a second seizure within the first two years. The study indicated the preventative medication may not affect the long-term possibility of reoccurrence.

Using AED medication as a preventative is considered safe as the side effects are typically mild and discontinue on their own. Side effects are usually experienced in a wide range of people, from 7% to 31%. Most patients are willing to tolerate any side effects to keep from having another seizure.

Many factors are assessed before starting a patient on AED treatment after their first seizure. Talk with your physician about any concerns you have about AED medications, including the benefits, risks, side effects, and interactions with other medications or supplements you may be taking.



The Epilepsy Foundation

National Institute of Health, National Library of Medicine

Topics: Seizure Management