Principles of Antiseizure Drug Management

Seizures are categorized as unprovoked or provoked, and the former may lead to the diagnosis of epilepsy. The term unprovoked seizure refers to a seizure of unknown etiology or that occurs in relation to a presenting brain lesion or progressive nervous system disorder. Provoked seizures are due to an acute condition such as toxic or metabolic disturbance, head trauma, or acute stroke. About 30% of patients with unprovoked seizures, which are nearly always generalized tonic–clonic convulsions, are seen by physicians after only a single attack. Studies have now established high-risk groups for recurrence after a single unprovoked seizure. The risk for epilepsy is greatly increased in the presence of an abnormal electroencephalogram (EEG), history of brain injury, and family history of epilepsy. 1 Age of onset may impact the choice of antiseizure drug (ASD). Etiologies often vary with age of onset. Prognosis, consequences of etiology, and response to treatment may vary depending on age and comorbid conditions.