Treatment Protocol

Clinicians should advise that immediate antiepileptic drug (AED) therapy, as compared with delay of treatment pending a second seizure, is likely to reduce the risk of a seizure recurrence within the first 2 years (absolute risk reduction of about 35%).

Patients should be informed that immediate therapy may not improve quality of life (QOL) measures.

Clinicians should advise that immediate AED treatment is unlikely to improve the prognosis for sustained seizure remission compared with treatment delayed until a second seizure occurs.

Patients should be informed that the risk of adverse events (AEs) ranges from 7% to 31%.

Patients should be advised that these are likely predominantly mild and reversible with dose reduction or drug switching.

Initial AED monotherapy with phenytoin or topiramate is associated with AEs leading to discontinuation in only 7% to 13% of patients.

Clinicians' recommendations should be based on individualized assessments that weigh recurrence risk against AEs, consider patient preferences, and explain that immediate treatment reduces short-term risk but does not improve long-term remission rates.

Appropriate evaluation to determine if the seizure is unprovoked or symptomatic is required before management decisions.