The management of patients with a single, unprovoked seizure is controversial. The likelihood of seizure recurrence after a first seizure has profound social, vocational, and emotional implications for the patient. The issue of whether or not to use anticonvulsant medication in these patients is an important part of this controversy and may be substantially affected by the true probability of seizure recurrence. The last word about recurrence of seizures following an initial, unprovoked seizure has yet to be written.
It is widely stated that only about 30% of adult patients who experience a single, unprovoked seizure will subsequently develop recurrent seizures (epilepsy). This figure is derived from several studies that differed in their patient populations and in their patients' use of anticonvulsants (Table). Further, the critical interval from the first seizure to entry into the study was often not defined in these studies. This interval is critical because all epileptics
Hart RG, Easton JD. Seizure Recurrence After a First, Unprovoked Seizure. Arch Neurol. 1986;43(12):1289–1290. doi:10.1001/archneur.1986.00520120065018