Initiation of phamacotherapy after a first generalized tonic-clonic seizure in adults: Contra

With the exception of acute symptomatic seizures, hints to a developing idi opathic epilepsy or an initial status epilepticus there is at present in ge neral no indication for the initiation of a therapy with antiepileptic drug s (AEDs) after a first generalized tonic-clonic seizure (GTCS) in adults fo r the following reasons: 1. For the individual patient with a first GTCS th ere is no reliable method to predict whether an epilepsy requiring AED trea tment will develop or not. 2. A syndrome-specific epilepsy diagnosis (with corresponding improvement in knowledge of spontaneous and therapeutic progn osis) is of ten not possible after a first GTCS. 3. A recurrence risk of ab out 50% for the following 2-3 years means that AEDs are not necessary in ab out every second patient 4. Several prospective studies have demonstrated t hat the long-term therapy prognosis does not depend on whether treatment is started after the first or second seizure. 5. In spite of initiation of AE D treatment after the first seizure 25-50% of the patients will have recurr ent seizures within the next 2 years. Even in patients with newly diagnosed focal seizures, the only randomized drug trial could only demonstrate marg inal benefits in comparison to placebo. 6. In patients with only rare seizu res the arguments regarding social consequences put forward by proponents o f treatment after the first seizure (second seizure = epilepsy with e.g. lo ss of driving license) are becoming less important due to new proposals of the international League against Epilepsy regarding so-called oligo-epileps y no longer necessarily as epilepsy.