Early treatment of a single generalized tonic-clonic seizure to prevent recurrence

Background: The question of whether to start antiepileptic treatment after a single unprovoked seizure remains controversial and has been the subject of much debate in the relevant literature. Objectives: To determine the rate of recurrence of a second attack after a single unprovoked epileptic seizure by using 2 study groups of treated and untreated patients and, thus, to establish a treatment policy for these patients. Patients and Methods: A group of 91 patients with a single generalized tonic-clonic seizure were prospectively studied; 87 of these patients completed the study. The end point of the study was 36 months after the single attack or the occurrence of a subsequent epileptic attack. The patients were randomly divided into 2 groups: 45 patients who immediately received anticonvulsive treatment and 42 who remained untreated for the follow-up period. Patients in the treated group were given mono therapy with carbamazepine. The results of recurrences were statistically analyzed by using the Kaplan-Meier method. Results: Results indicated a significantly higher percentage of seizure-free patients in the treated group compared with that in the untreated group (P=.001). The treated men were proved to be less at risk for recurrent seizures compared with treated women (P<.001 vs P=.03, respectively). Conclusion: Treatment after a single unprovoked seizure leads to a significant reduction in the risk of relapse of generalized tonic-clonic epilepsy.