New guideline for how to treat a person's first unprovoked seizure

A guideline developed by the American Academy of Neurology recommends a routine electroencephalogram (EEG) and brain scans be considered when diagnosing and treating adults who experience their first unprovoked seizure.

Evidence shows such tools often detect brain abnormalities that caused the seizure and predict seizure recurrence. The guideline is published in the November 20, 2007, issue of Neurology®, the medical journal of the American Academy of Neurology.

“Since even one seizure is a frightening, traumatic event with serious potential consequences, such as loss of driving privileges, limitations for employment and bodily injury, information about optimal, evidence-based approaches for treating people with a seizure is important,” said guideline author Allan Krumholz, MD, a neurologist at the University of Maryland Medical Center and a Fellow of the American Academy of Neurology.

To develop the guideline, the authors analyzed all available scientific studies on the topic.

The guideline recommends a routine EEG be considered as part of the diagnosis of a person with a first unprovoked seizure. “Evidence shows an EEG revealed abnormalities indicating epilepsy in about one in four patients and was predictive of seizure recurrence,” said Krumholz, who is also a professor of neurology at the University of Maryland School of Medicine.

The guideline also recommends CT or MRI brain scans be routinely considered since the scans are significantly abnormal in one of 10 patients, helping to indicate the cause of their seizure. “A CT scan or MRI may lead to the diagnosis of disorders such as a brain tumor, stroke, an infection, or other structural lesions and may help determine a person's risk for a second seizure,” said Krumholz.

For adults who experience their first unprovoked seizure, Krumholz says the results of an EEG, CT or MRI will influence aspects of patient care and management, including drug treatment, patient and family counseling, and the need for immediate hospitalization and subsequent follow-up.

Seizures are among the most common serious neurological disorders cared for by neurologists. Annually approximately 150,000 adults will have a first seizure in the United States. It is estimated that in 40 to 50 percent of these people, seizures recur and are classified as epilepsy.