PMID- 25901057
OWN - NLM
STAT- MEDLINE
DCOM- 20150706
LR  - 20220330
IS  - 1526-632X (Electronic)
IS  - 0028-3878 (Print)
IS  - 0028-3878 (Linking)
VI  - 84
IP  - 16
DP  - 2015 Apr 21
TI  - Evidence-based guideline: Management of an unprovoked first seizure in adults: 
      Report of the Guideline Development Subcommittee of the American Academy of 
      Neurology and the American Epilepsy Society.
PG  - 1705-13
LID - 10.1212/WNL.0000000000001487 [doi]
AB  - OBJECTIVE: To provide evidence-based recommendations for treatment of adults with 
      an unprovoked first seizure. METHODS: We defined relevant questions and 
      systematically reviewed published studies according to the American Academy of 
      Neurology's classification of evidence criteria; we based recommendations on 
      evidence level. RESULTS AND RECOMMENDATIONS: Adults with an unprovoked first 
      seizure should be informed that their seizure recurrence risk is greatest early 
      within the first 2 years (21%-45%) (Level A), and clinical variables associated 
      with increased risk may include a prior brain insult (Level A), an EEG with 
      epileptiform abnormalities (Level A), a significant brain-imaging abnormality 
      (Level B), and a nocturnal seizure (Level B). Immediate antiepileptic drug (AED) 
      therapy, as compared with delay of treatment pending a second seizure, is likely 
      to reduce recurrence risk within the first 2 years (Level B) but may not improve 
      quality of life (Level C). Over a longer term (>3 years), immediate AED treatment 
      is unlikely to improve prognosis as measured by sustained seizure remission 
      (Level B). Patients should be advised that risk of AED adverse events (AEs) may 
      range from 7% to 31% (Level B) and that these AEs are likely predominantly mild 
      and reversible. Clinicians' recommendations whether to initiate immediate AED 
      treatment after a first seizure should be based on individualized assessments 
      that weigh the risk of recurrence against the AEs of AED therapy, consider 
      educated patient preferences, and advise that immediate treatment will not 
      improve the long-term prognosis for seizure remission but will reduce seizure 
      risk over the subsequent 2 years.
CI  - (c) 2015 American Academy of Neurology.
FAU - Krumholz, Allan
AU  - Krumholz A
AD  - From the Department of Neurology, Maryland Epilepsy Center (A.K.), and Department 
      of Neurology (A.M.S., A.A.K., J.P.M., J.L.H.), University of Maryland School of 
      Medicine, Baltimore; US Department of Veterans Affairs (A.K.), Maryland 
      Healthcare System, Epilepsy Center of Excellence, Baltimore, MD; Department of 
      Clinical Neuroscience (S.W.), University of Calgary Faculty of Medicine, Canada; 
      Department of Neurology (G.S.G.), University of Kansas School of Medicine, Kansas 
      City, KS; Department of Neurology (D.S.G.), Geisinger Health System, Danville, 
      PA; Department of Emergency Medicine (A.T.L.), George Washington University 
      School of Medicine, Washington, DC; Department of Neurology (A.M.K.), 
      International Center for Epilepsy, University of Miami Miller School of Medicine, 
      FL; Departments of Neurology, Pediatrics, and Epidemiology & Population Health 
      (S.S.), Albert Einstein College of Medicine, Yeshiva University, Bronx; and New 
      York University Comprehensive Epilepsy Center (J.A.F.), New York, NY.
FAU - Wiebe, Samuel
AU  - Wiebe S
AD  - From the Department of Neurology, Maryland Epilepsy Center (A.K.), and Department 
      of Neurology (A.M.S., A.A.K., J.P.M., J.L.H.), University of Maryland School of 
      Medicine, Baltimore; US Department of Veterans Affairs (A.K.), Maryland 
      Healthcare System, Epilepsy Center of Excellence, Baltimore, MD; Department of 
      Clinical Neuroscience (S.W.), University of Calgary Faculty of Medicine, Canada; 
      Department of Neurology (G.S.G.), University of Kansas School of Medicine, Kansas 
      City, KS; Department of Neurology (D.S.G.), Geisinger Health System, Danville, 
      PA; Department of Emergency Medicine (A.T.L.), George Washington University 
      School of Medicine, Washington, DC; Department of Neurology (A.M.K.), 
      International Center for Epilepsy, University of Miami Miller School of Medicine, 
      FL; Departments of Neurology, Pediatrics, and Epidemiology & Population Health 
      (S.S.), Albert Einstein College of Medicine, Yeshiva University, Bronx; and New 
      York University Comprehensive Epilepsy Center (J.A.F.), New York, NY.
FAU - Gronseth, Gary S
AU  - Gronseth GS
AD  - From the Department of Neurology, Maryland Epilepsy Center (A.K.), and Department 
      of Neurology (A.M.S., A.A.K., J.P.M., J.L.H.), University of Maryland School of 
      Medicine, Baltimore; US Department of Veterans Affairs (A.K.), Maryland 
      Healthcare System, Epilepsy Center of Excellence, Baltimore, MD; Department of 
      Clinical Neuroscience (S.W.), University of Calgary Faculty of Medicine, Canada; 
      Department of Neurology (G.S.G.), University of Kansas School of Medicine, Kansas 
      City, KS; Department of Neurology (D.S.G.), Geisinger Health System, Danville, 
      PA; Department of Emergency Medicine (A.T.L.), George Washington University 
      School of Medicine, Washington, DC; Department of Neurology (A.M.K.), 
      International Center for Epilepsy, University of Miami Miller School of Medicine, 
      FL; Departments of Neurology, Pediatrics, and Epidemiology & Population Health 
      (S.S.), Albert Einstein College of Medicine, Yeshiva University, Bronx; and New 
      York University Comprehensive Epilepsy Center (J.A.F.), New York, NY.
FAU - Gloss, David S
AU  - Gloss DS
AD  - From the Department of Neurology, Maryland Epilepsy Center (A.K.), and Department 
      of Neurology (A.M.S., A.A.K., J.P.M., J.L.H.), University of Maryland School of 
      Medicine, Baltimore; US Department of Veterans Affairs (A.K.), Maryland 
      Healthcare System, Epilepsy Center of Excellence, Baltimore, MD; Department of 
      Clinical Neuroscience (S.W.), University of Calgary Faculty of Medicine, Canada; 
      Department of Neurology (G.S.G.), University of Kansas School of Medicine, Kansas 
      City, KS; Department of Neurology (D.S.G.), Geisinger Health System, Danville, 
      PA; Department of Emergency Medicine (A.T.L.), George Washington University 
      School of Medicine, Washington, DC; Department of Neurology (A.M.K.), 
      International Center for Epilepsy, University of Miami Miller School of Medicine, 
      FL; Departments of Neurology, Pediatrics, and Epidemiology & Population Health 
      (S.S.), Albert Einstein College of Medicine, Yeshiva University, Bronx; and New 
      York University Comprehensive Epilepsy Center (J.A.F.), New York, NY.
FAU - Sanchez, Ana M
AU  - Sanchez AM
AD  - From the Department of Neurology, Maryland Epilepsy Center (A.K.), and Department 
      of Neurology (A.M.S., A.A.K., J.P.M., J.L.H.), University of Maryland School of 
      Medicine, Baltimore; US Department of Veterans Affairs (A.K.), Maryland 
      Healthcare System, Epilepsy Center of Excellence, Baltimore, MD; Department of 
      Clinical Neuroscience (S.W.), University of Calgary Faculty of Medicine, Canada; 
      Department of Neurology (G.S.G.), University of Kansas School of Medicine, Kansas 
      City, KS; Department of Neurology (D.S.G.), Geisinger Health System, Danville, 
      PA; Department of Emergency Medicine (A.T.L.), George Washington University 
      School of Medicine, Washington, DC; Department of Neurology (A.M.K.), 
      International Center for Epilepsy, University of Miami Miller School of Medicine, 
      FL; Departments of Neurology, Pediatrics, and Epidemiology & Population Health 
      (S.S.), Albert Einstein College of Medicine, Yeshiva University, Bronx; and New 
      York University Comprehensive Epilepsy Center (J.A.F.), New York, NY.
FAU - Kabir, Arif A
AU  - Kabir AA
AD  - From the Department of Neurology, Maryland Epilepsy Center (A.K.), and Department 
      of Neurology (A.M.S., A.A.K., J.P.M., J.L.H.), University of Maryland School of 
      Medicine, Baltimore; US Department of Veterans Affairs (A.K.), Maryland 
      Healthcare System, Epilepsy Center of Excellence, Baltimore, MD; Department of 
      Clinical Neuroscience (S.W.), University of Calgary Faculty of Medicine, Canada; 
      Department of Neurology (G.S.G.), University of Kansas School of Medicine, Kansas 
      City, KS; Department of Neurology (D.S.G.), Geisinger Health System, Danville, 
      PA; Department of Emergency Medicine (A.T.L.), George Washington University 
      School of Medicine, Washington, DC; Department of Neurology (A.M.K.), 
      International Center for Epilepsy, University of Miami Miller School of Medicine, 
      FL; Departments of Neurology, Pediatrics, and Epidemiology & Population Health 
      (S.S.), Albert Einstein College of Medicine, Yeshiva University, Bronx; and New 
      York University Comprehensive Epilepsy Center (J.A.F.), New York, NY.
FAU - Liferidge, Aisha T
AU  - Liferidge AT
AD  - From the Department of Neurology, Maryland Epilepsy Center (A.K.), and Department 
      of Neurology (A.M.S., A.A.K., J.P.M., J.L.H.), University of Maryland School of 
      Medicine, Baltimore; US Department of Veterans Affairs (A.K.), Maryland 
      Healthcare System, Epilepsy Center of Excellence, Baltimore, MD; Department of 
      Clinical Neuroscience (S.W.), University of Calgary Faculty of Medicine, Canada; 
      Department of Neurology (G.S.G.), University of Kansas School of Medicine, Kansas 
      City, KS; Department of Neurology (D.S.G.), Geisinger Health System, Danville, 
      PA; Department of Emergency Medicine (A.T.L.), George Washington University 
      School of Medicine, Washington, DC; Department of Neurology (A.M.K.), 
      International Center for Epilepsy, University of Miami Miller School of Medicine, 
      FL; Departments of Neurology, Pediatrics, and Epidemiology & Population Health 
      (S.S.), Albert Einstein College of Medicine, Yeshiva University, Bronx; and New 
      York University Comprehensive Epilepsy Center (J.A.F.), New York, NY.
FAU - Martello, Justin P
AU  - Martello JP
AD  - From the Department of Neurology, Maryland Epilepsy Center (A.K.), and Department 
      of Neurology (A.M.S., A.A.K., J.P.M., J.L.H.), University of Maryland School of 
      Medicine, Baltimore; US Department of Veterans Affairs (A.K.), Maryland 
      Healthcare System, Epilepsy Center of Excellence, Baltimore, MD; Department of 
      Clinical Neuroscience (S.W.), University of Calgary Faculty of Medicine, Canada; 
      Department of Neurology (G.S.G.), University of Kansas School of Medicine, Kansas 
      City, KS; Department of Neurology (D.S.G.), Geisinger Health System, Danville, 
      PA; Department of Emergency Medicine (A.T.L.), George Washington University 
      School of Medicine, Washington, DC; Department of Neurology (A.M.K.), 
      International Center for Epilepsy, University of Miami Miller School of Medicine, 
      FL; Departments of Neurology, Pediatrics, and Epidemiology & Population Health 
      (S.S.), Albert Einstein College of Medicine, Yeshiva University, Bronx; and New 
      York University Comprehensive Epilepsy Center (J.A.F.), New York, NY.
FAU - Kanner, Andres M
AU  - Kanner AM
AD  - From the Department of Neurology, Maryland Epilepsy Center (A.K.), and Department 
      of Neurology (A.M.S., A.A.K., J.P.M., J.L.H.), University of Maryland School of 
      Medicine, Baltimore; US Department of Veterans Affairs (A.K.), Maryland 
      Healthcare System, Epilepsy Center of Excellence, Baltimore, MD; Department of 
      Clinical Neuroscience (S.W.), University of Calgary Faculty of Medicine, Canada; 
      Department of Neurology (G.S.G.), University of Kansas School of Medicine, Kansas 
      City, KS; Department of Neurology (D.S.G.), Geisinger Health System, Danville, 
      PA; Department of Emergency Medicine (A.T.L.), George Washington University 
      School of Medicine, Washington, DC; Department of Neurology (A.M.K.), 
      International Center for Epilepsy, University of Miami Miller School of Medicine, 
      FL; Departments of Neurology, Pediatrics, and Epidemiology & Population Health 
      (S.S.), Albert Einstein College of Medicine, Yeshiva University, Bronx; and New 
      York University Comprehensive Epilepsy Center (J.A.F.), New York, NY.
FAU - Shinnar, Shlomo
AU  - Shinnar S
AD  - From the Department of Neurology, Maryland Epilepsy Center (A.K.), and Department 
      of Neurology (A.M.S., A.A.K., J.P.M., J.L.H.), University of Maryland School of 
      Medicine, Baltimore; US Department of Veterans Affairs (A.K.), Maryland 
      Healthcare System, Epilepsy Center of Excellence, Baltimore, MD; Department of 
      Clinical Neuroscience (S.W.), University of Calgary Faculty of Medicine, Canada; 
      Department of Neurology (G.S.G.), University of Kansas School of Medicine, Kansas 
      City, KS; Department of Neurology (D.S.G.), Geisinger Health System, Danville, 
      PA; Department of Emergency Medicine (A.T.L.), George Washington University 
      School of Medicine, Washington, DC; Department of Neurology (A.M.K.), 
      International Center for Epilepsy, University of Miami Miller School of Medicine, 
      FL; Departments of Neurology, Pediatrics, and Epidemiology & Population Health 
      (S.S.), Albert Einstein College of Medicine, Yeshiva University, Bronx; and New 
      York University Comprehensive Epilepsy Center (J.A.F.), New York, NY.
FAU - Hopp, Jennifer L
AU  - Hopp JL
AD  - From the Department of Neurology, Maryland Epilepsy Center (A.K.), and Department 
      of Neurology (A.M.S., A.A.K., J.P.M., J.L.H.), University of Maryland School of 
      Medicine, Baltimore; US Department of Veterans Affairs (A.K.), Maryland 
      Healthcare System, Epilepsy Center of Excellence, Baltimore, MD; Department of 
      Clinical Neuroscience (S.W.), University of Calgary Faculty of Medicine, Canada; 
      Department of Neurology (G.S.G.), University of Kansas School of Medicine, Kansas 
      City, KS; Department of Neurology (D.S.G.), Geisinger Health System, Danville, 
      PA; Department of Emergency Medicine (A.T.L.), George Washington University 
      School of Medicine, Washington, DC; Department of Neurology (A.M.K.), 
      International Center for Epilepsy, University of Miami Miller School of Medicine, 
      FL; Departments of Neurology, Pediatrics, and Epidemiology & Population Health 
      (S.S.), Albert Einstein College of Medicine, Yeshiva University, Bronx; and New 
      York University Comprehensive Epilepsy Center (J.A.F.), New York, NY.
FAU - French, Jacqueline A
AU  - French JA
AD  - From the Department of Neurology, Maryland Epilepsy Center (A.K.), and Department 
      of Neurology (A.M.S., A.A.K., J.P.M., J.L.H.), University of Maryland School of 
      Medicine, Baltimore; US Department of Veterans Affairs (A.K.), Maryland 
      Healthcare System, Epilepsy Center of Excellence, Baltimore, MD; Department of 
      Clinical Neuroscience (S.W.), University of Calgary Faculty of Medicine, Canada; 
      Department of Neurology (G.S.G.), University of Kansas School of Medicine, Kansas 
      City, KS; Department of Neurology (D.S.G.), Geisinger Health System, Danville, 
      PA; Department of Emergency Medicine (A.T.L.), George Washington University 
      School of Medicine, Washington, DC; Department of Neurology (A.M.K.), 
      International Center for Epilepsy, University of Miami Miller School of Medicine, 
      FL; Departments of Neurology, Pediatrics, and Epidemiology & Population Health 
      (S.S.), Albert Einstein College of Medicine, Yeshiva University, Bronx; and New 
      York University Comprehensive Epilepsy Center (J.A.F.), New York, NY.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Neurology
JT  - Neurology
JID - 0401060
RN  - 0 (Anticonvulsants)
SB  - IM
CIN - Neurology. 2015 Oct 27;85(17):15255-6
CIN - Neurology. 2015 Oct 27;85(17):1527
CIN - Ann Intern Med. 2015 Sep 15;163(6):JC8. PMID: 26370035
CIN - Neurology. 2015 Oct 27;85(17):1525. PMID: 26503588
CIN - Neurology. 2015 Oct 27;85(17):1526-7. PMID: 26503589
CIN - Neurology. 2015 Oct 27;85(17):15255-6. PMID: 26811855
CIN - Neurology. 2015 Oct 27;85(17):1527. PMID: 26811856
CIN - JAMA. 2016 Oct 18;316(15):1590-1591. PMID: 27755622
MH  - Adult
MH  - Anticonvulsants/adverse effects/*therapeutic use
MH  - Evidence-Based Medicine/*standards
MH  - Humans
MH  - Practice Guidelines as Topic/*standards
MH  - Risk
MH  - Seizures/drug therapy/*therapy
MH  - Societies, Medical/*standards
PMC - PMC4409581
EDAT- 2015/04/23 06:00
MHDA- 2015/07/07 06:00
PMCR- 2015/10/21
CRDT- 2015/04/23 06:00
PHST- 2015/04/23 06:00 [entrez]
PHST- 2015/04/23 06:00 [pubmed]
PHST- 2015/07/07 06:00 [medline]
PHST- 2015/10/21 00:00 [pmc-release]
AID - WNL.0000000000001487 [pii]
AID - NEUROLOGY2014583278 [pii]
AID - 10.1212/WNL.0000000000001487 [doi]
PST - ppublish
SO  - Neurology. 2015 Apr 21;84(16):1705-13. doi: 10.1212/WNL.0000000000001487.