When do we treat?
Single epileptic seizures: we usually do not treat a single epileptic seizure. The main reason is that the likelihood of a second seizure is less than 50%. We would not want to expose the person to long term treatment with potential side effects to prevent a second seizure that might never happen.
When do we treat a single seizure?
• When there is evidence that a second seizure is likely to happen. The likelihood of there being a second seizure increases if we have an abnormal EEG or MRI.
• When there is a potential risk. For example if the patient had a very lengthy first seizure, we may feel treatment is necessary since the patient could conceivably have another prolonged seizure and this could lead to severe complications like for example brain damage.
Recurrent seizures:
Do we always treat recurrent seizures (epilepsy)?
• Most of the times we do treat epilepsy. The reason for this is that we want to prevent any future seizures or stronger seizures from happening. When the decision to treat is made, the next step is to choose the most appropriate anticonvulsant.
• We could choose not to treat only when:
- The patient only experiences auras (simple partial seizures) that are not disabling. However, this decision must be made carefully because there is the risk of the patient having a stronger seizure at some point.
- The patient only has night time seizures that are typically not associated with brain damage. A patient with benign rolandic epilepsy would be an example of this. In this case, the seizures are restricted to sleep (at least most of the times) and they are outgrown by adolescence.