Non-medical treatment of first epileptic seizures in adolescence and adulthood

Preliminary results are presented of a prospective study of patients who after a first seizure were treated by avoidance of seizure-precipitating factors. Thirty patients have been enrolled of whom 13 (43.3%) already had had a relapse before study onset. Twenty-three patients have been followed for 12 to 102 months, and of these a total of 7 relapses were observed. The recurrence rate in the first year of follow-up was 17.4%, much below the rate expected from the previously observed relapses. Mostly, the relapses were caused by the same precipitating factors as before. The risk of relapse was not influenced by drug treatment, electroencephalogram findings, focal signs, and positive antecedents, but there was a non-significant trend of previous relapses to increase this risk. The observed seizure recurrences with antiepileptic drug treatment indicate that, if drugs are prescribed, a careful choice of medication is necessary even after a single seizure, and low-dose therapy may not be sufficient. However, careful evaluation of individual factors precipitating the first seizure(s), and careful subsequent avoidance of these factors seems to be a more efficient therapeutic strategy than pharmacotherapy.