BACKGROUND Approximately 6% of the population will experience at least
one afebrile seizure in their lifetime. OBJECTIVE To review the progn
ostic factors and clinical implications for recurrence, remission, and
relapse of seizures. SUMMARY Antiepileptic drug treatment reduces the
risk of recurrence after a first seizure by about half, but these dru
gs cause a variety of adverse effects. The risk of recurrence is highe
r in the presence of neurologic or electroencephalographic abnormaliti
es or if the seizure is partial as opposed to generalized. Neurologic
abnormalities and partial seizures also reduce the probability of remi
ssion. Gradual drug withdrawal can be considered if the patient has be
en in remission for 2 years in the absence of any negative prognostic
indicators. CONCLUSIONS When deciding whether to begin or discontinue
antiepileptic drug therapy, clinicians should consider the risks and p
ossible benefits for the individual patient.