It is easier to agree in principle than on specifics. Dr Hauser states that "the potential for benefit by therapy should exceed the risk associated with initiation of therapy," a point that Drs Hart and Easton would not deny. The differences arise from differing estimates of the likelihood of seizure recurrence, Dr Hauser's graph suggesting it to be about one third, whereas Drs Hart and Easton quote a study of 133 untreated patients whose recurrence rate was 71%.1
Variability in where and how the studies were carried out may account for the different estimates. What is clear is that someone with a first seizure has a significant risk of recurrence, usually within the first six months. The decision to treat will be largely based on the following considerations:
1. The nature of the lesion.
A seizure associated with a structural lesion and epileptogenic activity on the electroencephalogram may justify
Hachinski —. Management of a First Seizure. Arch Neurol. 1986;43(12):1290. doi:10.1001/archneur.1986.00520120066019
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