When to Treat Seizures With Medicine

The answer depends on the type of seizure.

A seizure medicine is usually started if a person has had more than one seizure. Yet, a medicine may also be started if a person has only one seizure, but other tests (such as an MRI or EEG) suggest a risk for more seizures in the future.

• Absence Seizures: When a child has had a single absence seizure and the EEG shows a typical pattern associated with this seizure type, then it's likely that the child has had other unwitnessed staring events. In this situation, a seizure medicine is usually recommended.
• Partial Seizures: A person who had been diagnosed with partial seizures may have had previous events that were not noticed or recognized as seizures. Unfortunately, many people don't see a doctor unless a more pronounced event or convulsion has occurred. If a partial seizure has definitely occurred, many doctors recommend treatment, because there is a high chance of having more seizures.
• Tonic-Clonic Seizures: The question is more difficult for a single tonic-clonic (grand mal) seizure. The chance of another seizure can be up to 66%, depending on the circumstances surrounding the seizure and results of a neurological exam or other tests.

Guidelines on when to treat a first seizure found that starting seizure medications after the first seizure can lessen the risk for more seizures in the first 2 years. The report also found:

• When an adult has an unprovoked seizure, the risk for more seizures without treatment in the next 2 years can range 21 to 45%.
• This risk is greatest in people who have had a brain injury (such as stroke or trauma) and seizure activity is seen on the EEG. Other factors that may lead to a higher risk for seizures in the first 2 years are other abnormalities on brain imaging tests and seizures at night.
• Starting a seizure medication right away may help lessen this early risk, but does not seem to affect the long-term risk of seizures.
• The risk of side effects from seizure medications may range from 7 to 31%. Medication side effects are usually mild and go away
• Early treatment may not affect the person's quality of life over time.