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Should someone start drug treatment after only one seizure?

BMJ Group Medical Reference

If you or your child has had a seizure, you may wonder whether you should start treatment for epilepsy. Experts generally agree that most people (but not all) should wait until they've had at least two seizures before starting treatment. [30] This is because:

  • Having one seizure doesn't mean you'll have another

  • Having one seizure doesn't mean you have epilepsy

  • Drugs have side effects, so it makes sense to be sure that you have epilepsy before you start taking them.

Nearly two-thirds of people who have had one seizure don't have another within the next two years. For these people, treatment may not be necessary.

The trouble is, it can be hard for doctors to work out your individual chances of having another seizure. There is little research to say why some people have further seizures and some people don't.

It's also hard to know for certain how many seizures you or your child have had. Some seizures are mild, so you might not have noticed them. This can make it difficult to decide whether you should start treatment. [30] [31]

It's likely that you will cut your chances of having another seizure if you take epilepsy drugs. Research shows that taking an epilepsy drug straight away can:

  • Reduce the risk of a second seizure in the next two years by more than half [31] [32] [33] [34]

  • Increase the length of time between your first and second seizures. [35]

But taking epilepsy drugs may not stop you having more seizures in the long run. [31] [35] One study found that as many people had been free of seizures five years later whether or not they'd started treatment straight away. [35]

Taking epilepsy drugs can also cause side effects. [30] [33] [34] [35] And having to take tablets every day can be a bind. This is why you might want to wait.

To help you decide, your doctor will consider a couple of things.

  • First, your doctor will work out if the symptoms you describe are actually a seizure. For example, a mild stroke (a mini-stroke) may look and feel like a seizure.

  • If you did have a seizure, your doctor should send you to see a specialist.

  • The specialist (usually a neurologist) will need to rule out other things that could have caused your seizure besides epilepsy. You may need to have tests, such as an electroencephalogram (EEG), to check the electrical activity in your brain. If this activity is abnormal, you may have epilepsy. An EEG may also tell you what type of seizure you had. (To learn more, see How do doctors diagnose epilepsy?)

If you do need to see a specialist, you shouldn't have to wait more than two weeks for an appointment. [12] That's according to guidelines from the National Institute for Health and Clinical Excellence (NICE), the government body that decides which tests and treatments should be available on the NHS.

Last Updated: June 20, 2012
This information does not replace medical advice.  If you are concerned you might have a medical problem please ask your Boots pharmacy team in your local Boots store, or see your doctor.

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