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The AAN has issued updated recommendations for treating first seizure in adults. Adults still need an EEG and brain imaging. JR
Adults presenting with an unprovoked first seizure should be informed that the chance for a recurrent seizure is greatest within the first 2 years after a first seizure (21%–45%) (Level A).
Clinicians should also advise such patients that clinical factors associated with an increased risk of seizure recurrence include a prior brain insult such as a stroke or trauma (Level A), an EEG with epileptiform abnormalities (Level A), a significant brain-imaging abnormality (Level B), or a nocturnal seizure (Level B).
Clinicians should advise patients that, although immediate AED therapy, as compared with delay of treatment pending a second seizure, is likely to reduce the risk of a seizure recurrence in the 2 years subsequent to a first seizure (Level B), it may not improve QOL (Level C).
Clinicians should advise patients that over the longer term (>3 years), immediate AED treatment is unlikely to improve the prognosis for sustained seizure remission (Level B).
Patients should be advised that their risk for AED AEs ranges from 7% to 31% (Level B) and that these AEs are predominantly mild and reversible.
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