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Should People Be Treated After a First Seizure?

Should People Be Treated After a First Seizure? Abstract The occurrence of a seizure is a frightening event, both for the individual affected and for those who witness the episode. If medical attention is sought, the clinician must determine both the potential underlying or precipitating cause of the event and decide what therapeutic intervention, if any, is warranted. In general, the latter decision is based on the former determination. In situations in which a clearly remediable cause of seizures is identified, the need for short- or long-term therapy with anticonvulsant drugs (ACDs) may be less important than the need for timely intervention to remedy the primary problem. When no potentially remediable metabolic or structural abnormality is identified, the clinician is still faced with a decision of whether to recommend short- or long-term ACD therapy. It should be clear that the potential for benefit of the therapy should exceed the risk associated with initiation of the therapy. Thus, the frequency References 1. Leppik I, Lapora J, Loewenson R: Seasonal incidence of phenytoin allergy unrelated to plasma levels . Arch Neurol 1985;42:120-123.Crossref 2. Wilson JT, Hojer B, Tomson G, et al: High incidence of a concentration-dependent skin reaction in children treated with phenytoin . Br Med J 1978;1:1583-1586.Crossref 3. Ramsay RE, Wilder BJ, Berger JR, et al: A double-blind study comparing carbamazepine with phenytoin as initial seizure therapy in adults . Neurology 1983;33:904-910.Crossref 4. Wolf SM, Forsythe A: Behavior disturbance, phenobarbital, and febrile seizures . Pediatrics 1978;61:728-731. 5. Camfield CS, Chaplin S, Doyle A-B, et al: Side effects of phenobarbital in toddlers: Behavioral and cognitive aspects . J Pediatr 1979;95:361-365.Crossref 6. Thorn I: A controlled study of prophylactic long-term treatment of febrile convulsions with phenobarbital . Acta Neurol Scand Suppl 1975;60:67-73.Crossref 7. Chadwick D, Reynolds EH, Maraden CD: Anticonvulsant-induced dyskinesias: A comparison with dyskinesias induced by neuroleptics . J Neurol Neurosurg Psychiatry 1976;39:1210-1214.Crossref 8. Ferrari M, Barbas G, Matthews WS: Psychological and behavioral disturbance among epileptic children treated with barbiturate anticonvulsants . Am J Psychiatry 1983;140:112-113. 9. Silverstein FS, Parrish MA, Johnston MV: Adverse behavioral reactions in children treated with carbamazepine . J Pediatr 1982;101:785-787.Crossref 10. Sonnen AEH, Zelvelder WH, Bruens JH: A double-blind study of the influence of dipropylacetate on behavior . Acta Neurol Scand Suppl 1975;60:43-47.Crossref 11. Hutt SJ, Jackson PM, Belsham AB, et al: Perceptual motor behavior in relation to blood phenobarbitone level: A preliminary report . Dev Med Child Neurol 1968;10:626-632.Crossref 12. Thompson PJ, Huppert FA, Trimble MR: Phenytoin and cognitive function: Effects on normal volunteers and implications for epilepsy . Br J Clin Psychol 1981;20:155-162.Crossref 13. Vining EPG, Mellitus ED, Cataldo MR, et al: Effects of phenobarbital and sodium valproate on neuropsychological function and behavior . Ann Neurol 1983;14:360. 14. Dodrill CH: Diphenylhydantoin serum levels, toxicity, and neuropsychological performance in patients with epilepsy . Epilepsia 1975;16:593-600.Crossref 15. Thompson PJ, Trimble MR: Sodium valproate and cognitive functioning in normal volunteers . Br J Clin Pharmacol 1981;12:819-824. 16. Thompson PJ, Trimble MR: Anticonvulsant serum levels: Relationship to impairments of cognitive functioning . J Neurol Neurosurg Psychiatry 1983;46:227-233.Crossref 17. Thompson PJ, Trimble MR: Anticonvulsant drugs and cognitive functions . Epilepsia 1982;23:531-544.Crossref 18. Andrews DG, Tomlinson L, Elwes RDC, et al: The influence of carbamazepine and phenytoin on memory and other aspects of cognitive functions in new referrals with epilepsy . Acta Neurol Scand 1983;69( (suppl 99) ):23-30.Crossref 19. Trimble MR, Thompson PJ: Sodium valproate and cognitive function . Epilepsia 1984;25( (suppl 1) ):860-864.Crossref 20. Mattson RH, Cramer JA, Collins JF, et al: Comparison of carbamazepine, phenobarbital, phenytoin, and primidone in partial and secondarily generalized tonic-clonic seizures . N Engl J Med 1985;313:145-151.Crossref 21. Hauser WA, Kurland LT: The epidemiology of epilepsy in Rochester, Minnesota, 1935-1967 . Epilepsia 1975;16:1-66.Crossref 22. Hauser WA, Anderson VE, Loewenson RB, et al: Seizure recurrence after a first unprovoked seizure . N Engl J Med 1982;307:522-528.Crossref 23. Hauser WA, Rich SS, Jacobs MP, et al: Patterns of seizure occurrence and recurrence risks in patients with newly diagnosed epilepsy . Epilepsia 1983;24:516. 24. Hirtz DC, Ellenberg JH, Nelson KB: The risk of recurrence of nonfebrile seizures in children . Neurology 1984;34:637-641.Crossref 25. Camfield PR, Camfield CS, Smith ED, et al: Newly treated childhood epilepsy: A prospective study of recurrences and side effects . Neurology 1985;35:722-725.Crossref 26. Annegers JF, Shirts SB, Hauser WA, et al: Risk of recurrence after an initial unprovoked seizure . Epilepsia 1986;27:43-50.Crossref 27. Elwes RDC, Chesterman P, Reynolds EH: Prognosis after a first untreated tonic-clonic seizure . Lancet 1985;2:752-753.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Should People Be Treated After a First Seizure?

Archives of Neurology , Volume 43 (12) – Dec 1, 1986

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References (30)

Publisher
American Medical Association
Copyright
Copyright © 1986 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1986.00520120063017
Publisher site
See Article on Publisher Site

Abstract

Abstract The occurrence of a seizure is a frightening event, both for the individual affected and for those who witness the episode. If medical attention is sought, the clinician must determine both the potential underlying or precipitating cause of the event and decide what therapeutic intervention, if any, is warranted. In general, the latter decision is based on the former determination. In situations in which a clearly remediable cause of seizures is identified, the need for short- or long-term therapy with anticonvulsant drugs (ACDs) may be less important than the need for timely intervention to remedy the primary problem. When no potentially remediable metabolic or structural abnormality is identified, the clinician is still faced with a decision of whether to recommend short- or long-term ACD therapy. It should be clear that the potential for benefit of the therapy should exceed the risk associated with initiation of the therapy. Thus, the frequency References 1. Leppik I, Lapora J, Loewenson R: Seasonal incidence of phenytoin allergy unrelated to plasma levels . Arch Neurol 1985;42:120-123.Crossref 2. Wilson JT, Hojer B, Tomson G, et al: High incidence of a concentration-dependent skin reaction in children treated with phenytoin . Br Med J 1978;1:1583-1586.Crossref 3. Ramsay RE, Wilder BJ, Berger JR, et al: A double-blind study comparing carbamazepine with phenytoin as initial seizure therapy in adults . Neurology 1983;33:904-910.Crossref 4. Wolf SM, Forsythe A: Behavior disturbance, phenobarbital, and febrile seizures . Pediatrics 1978;61:728-731. 5. Camfield CS, Chaplin S, Doyle A-B, et al: Side effects of phenobarbital in toddlers: Behavioral and cognitive aspects . J Pediatr 1979;95:361-365.Crossref 6. Thorn I: A controlled study of prophylactic long-term treatment of febrile convulsions with phenobarbital . Acta Neurol Scand Suppl 1975;60:67-73.Crossref 7. Chadwick D, Reynolds EH, Maraden CD: Anticonvulsant-induced dyskinesias: A comparison with dyskinesias induced by neuroleptics . J Neurol Neurosurg Psychiatry 1976;39:1210-1214.Crossref 8. Ferrari M, Barbas G, Matthews WS: Psychological and behavioral disturbance among epileptic children treated with barbiturate anticonvulsants . Am J Psychiatry 1983;140:112-113. 9. Silverstein FS, Parrish MA, Johnston MV: Adverse behavioral reactions in children treated with carbamazepine . J Pediatr 1982;101:785-787.Crossref 10. Sonnen AEH, Zelvelder WH, Bruens JH: A double-blind study of the influence of dipropylacetate on behavior . Acta Neurol Scand Suppl 1975;60:43-47.Crossref 11. Hutt SJ, Jackson PM, Belsham AB, et al: Perceptual motor behavior in relation to blood phenobarbitone level: A preliminary report . Dev Med Child Neurol 1968;10:626-632.Crossref 12. Thompson PJ, Huppert FA, Trimble MR: Phenytoin and cognitive function: Effects on normal volunteers and implications for epilepsy . Br J Clin Psychol 1981;20:155-162.Crossref 13. Vining EPG, Mellitus ED, Cataldo MR, et al: Effects of phenobarbital and sodium valproate on neuropsychological function and behavior . Ann Neurol 1983;14:360. 14. Dodrill CH: Diphenylhydantoin serum levels, toxicity, and neuropsychological performance in patients with epilepsy . Epilepsia 1975;16:593-600.Crossref 15. Thompson PJ, Trimble MR: Sodium valproate and cognitive functioning in normal volunteers . Br J Clin Pharmacol 1981;12:819-824. 16. Thompson PJ, Trimble MR: Anticonvulsant serum levels: Relationship to impairments of cognitive functioning . J Neurol Neurosurg Psychiatry 1983;46:227-233.Crossref 17. Thompson PJ, Trimble MR: Anticonvulsant drugs and cognitive functions . Epilepsia 1982;23:531-544.Crossref 18. Andrews DG, Tomlinson L, Elwes RDC, et al: The influence of carbamazepine and phenytoin on memory and other aspects of cognitive functions in new referrals with epilepsy . Acta Neurol Scand 1983;69( (suppl 99) ):23-30.Crossref 19. Trimble MR, Thompson PJ: Sodium valproate and cognitive function . Epilepsia 1984;25( (suppl 1) ):860-864.Crossref 20. Mattson RH, Cramer JA, Collins JF, et al: Comparison of carbamazepine, phenobarbital, phenytoin, and primidone in partial and secondarily generalized tonic-clonic seizures . N Engl J Med 1985;313:145-151.Crossref 21. Hauser WA, Kurland LT: The epidemiology of epilepsy in Rochester, Minnesota, 1935-1967 . Epilepsia 1975;16:1-66.Crossref 22. Hauser WA, Anderson VE, Loewenson RB, et al: Seizure recurrence after a first unprovoked seizure . N Engl J Med 1982;307:522-528.Crossref 23. Hauser WA, Rich SS, Jacobs MP, et al: Patterns of seizure occurrence and recurrence risks in patients with newly diagnosed epilepsy . Epilepsia 1983;24:516. 24. Hirtz DC, Ellenberg JH, Nelson KB: The risk of recurrence of nonfebrile seizures in children . Neurology 1984;34:637-641.Crossref 25. Camfield PR, Camfield CS, Smith ED, et al: Newly treated childhood epilepsy: A prospective study of recurrences and side effects . Neurology 1985;35:722-725.Crossref 26. Annegers JF, Shirts SB, Hauser WA, et al: Risk of recurrence after an initial unprovoked seizure . Epilepsia 1986;27:43-50.Crossref 27. Elwes RDC, Chesterman P, Reynolds EH: Prognosis after a first untreated tonic-clonic seizure . Lancet 1985;2:752-753.Crossref

Journal

Archives of NeurologyAmerican Medical Association

Published: Dec 1, 1986

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