The single seizure. To treat or not to treat?

It is generally accepted that anticonvulsant therapy should be offered once a patient has experienced 2 or more seizures. However, there is controversy over whether treatment should be offered after a single seizure. The type of epileptic event that has occurred may determine whether or not a single episode will bring the individual to medical attention. In individuals who experience a single seizure, there is significantly increased risk of recurrence if neurological or paroxysmal electroencephalogram abnormalities are present or if the seizure is partial. Anticonvulsant therapy, if taken as prescribed after a single seizure, will substantially reduce the risk of seizure recurrence. Unless a further seizure would hold little disadvantage, early treatment probably offers distinctly more benefit than hazard. No data are available to indicate the most appropriate duration of therapy after a single seizure.