The Guideline Development Subcommittee of the American Academy of Neurology and the American Epilepsy Society addressed seizure recurrence, immediate treatment with antiepileptic drugs (AEDs), and adverse events (AEs) related to AEDs in patients with an unprovoked first seizure. The risk of recurrence after an unprovoked first seizure is greatest within the first 2 years, especially in the first year. Immediate AED therapy after an unprovoked first seizure reduces the risk of seizure recurrence by approximately 35% within the subsequent 2 years; however, immediate treatment with AED is unlikely to improve sustained seizure remission over the longer term (>3 years). Adverse events associated with the immediate treatment of unprovoked first seizure with AEDs are predominantly mild and reversible, occurring in about 7% to 31% of patients.
Krumholz A, Wiebe S, Gronseth GS, et al. Evidence-based guideline: management of an unprovoked first seizure in adults. Neurology. 2015;84(16):1705-1713.