Posted on December 9, 2009, under Epilepsy.
A person who has had two or three seizures does not necessarily need treatment. For example, an adult who has two or three generalized tonic-clonic seizures (grand mal fits) in a two-week period and who might lose his job if he had a seizure at work requires early treatment, whereas a child who has cerebral palsy and learning difficulties and who had had two partial seizures six months apart does not necessarily require treatment with anti-epileptic drugs. Remember also that there are people whose seizures can be clearly attributed in part to a non-recurring cause. For example, seizures may begin for the first time whilst the person is on an antidepressant drug, such as amitriptyline, which is known to induce seizures in some people. Clearly the drug is not the only factor. Thousands of people take amitriptyline without having seizures. In those who do, the drug presumably acts on those with a low seizure threshold. Nevertheless it would seem reasonable to see how such a person gets on without antidepressants, before prescribing anti-epileptic medication. Other precipitating factors, if specific, such as occur in epilepsy induced by television may be avoided, and make anti-epileptic medication unnecessary.
It is therefore important that each patient is considered as an individual. The choice of whether or not anti-epileptic medication should be used is made in equal partnership between patient (or parent) and doctor. For example, a woman may wish to avoid anti-epileptic medication if planning a pregnancy even though her chances of further seizures are high.
One common decision that has to be made is whether or not to start anti-epileptic medication after a single seizure in an adult, often for which no clearly defined precipitating factor can be identified. It used to be advised that ‘one seizure did not make a diagnosis of epilepsy’. Although true by definition, the risk of a second seizure is in adults as high as 78% over the next three years, the risk being its highest in the first few weeks. Recent trials have shown clearly that an anti-epileptic drug given after the first seizure does significantly reduce the chances of a second. Patients should be offered the choice of anti-epileptic medication at this stage, with a clear explanation of the risks of further seizures and the relative drawbacks of medication, even though a number will decide to take their chances.