The treatment of the first seizure: The risks

The risks associated with prescribing antiepileptic drugs (AEDs) in a person who had a single unprovoked seizure fall into three domains: (1) the risk that treatment will not be effective in preventing seizure relapse, and the consequences thereof; (2) the risks of a person's life being affected by the psychological, social, and legal aspects of receiving treatment for a seizure disorder; (3) the health risks associated with intake of antiepileptic medication. This article with focus on the latter, addressing in particular concerns related to adverse drug effects. Serious or life-threatening adverse reactions are very uncommon in people started on AEDs, although some (e.g., teratogenic effects) can be a major concern in specific patient groups. Nonserious adverse reactions leading to withdrawal of treatment are relatively common, although in most cases these are reversible following removal of the offending agent. Adverse effects associated with prolonged treatment and not leading to drug withdrawal are an important concern, because such effects are often under-recognized and may affect significantly quality of life. Additional risks relate to the occurrence of drug-drug interactions. In all cases, risks can be minimized by careful selection of the AED to be used (with particular consideration of individual characteristics which contraindicate a specific AED, or predispose to specific adverse effects), gradual dose titration, choice of an appropriate target dose and, most important of all, careful monitoring of clinical response.