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The Argument for a More Patient Attitude Toward a Single Unprovoked Seizure

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Published:December 02, 2022DOI:https://doi.org/10.1016/j.mayocp.2022.10.009
      Approximately 10% of the population will experience a seizure during their lifetime, whereas only 2% to 3% will develop epilepsy.
      • Hauser W.A.
      • Annegers J.F.
      • Kurland L.T.
      Incidence of epilepsy and unprovoked seizures in Rochester, Minnesota: 1935-1984.
      ,
      • Berg A.T.
      • Shinnar S.
      The risk of seizure recurrence following a first unprovoked seizure: a quantitative review.
      Determining whether a first seizure or recurrent seizures are provoked or unprovoked is fundamentally essential for diagnosis and treatment. Patients with provoked seizures, also known as acute symptomatic seizures (eg, electrolyte disorders, toxins, head injury, or infectious processes) do not require long-term antiseizure medication (ASM) therapy.
      • Fisher R.S.
      • Acevedo C.
      • Arzimanoglou A.
      • et al.
      ILAE official report: a practical clinical definition of epilepsy.
      • Beghi E.
      • Carpio A.
      • Forsgren L.
      • et al.
      Recommendation for a definition of acute symptomatic seizure.
      • Chen B.
      • Lopez Chiriboga A.S.
      • Sirven J.I.
      • Feyissa A.M.
      Autoimmune encephalitis-related seizures and epilepsy: diagnostic and therapeutic approaches.
      Certainly, a seizure provoked by a reversible insult does not fall under the definition of epilepsy. On the other hand, patients with two unprovoked seizures are routinely treated with ASM, given the high risk for recurrent seizures (epilepsy), up to 57% by 1 year and 73% by 4 years.
      • Hauser W.A.
      • Rich S.S.
      • Lee J.R.
      • Annegers J.F.
      • Anderson V.E.
      Risk of recurrent seizures after two unprovoked seizures.

      Abbreviations and Acronyms:

      AAN (American Academy of Neurology), ASM (antiseizure medication), EEG (electroencephalogram), ES (epileptic seizure), ILAE (International League Against Epilepsy), PNES (psychogenic nonepileptic seizures), pPNES (prolonged psychogenic nonepileptic seizures), RCT (randomized controlled trial)
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