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Idiopathic First Seizure in Adult Life:Who Should be Treated? BMJ 302:620-623, vanDonselaar,C.A.,et al, 1991 See this aricle in Pubmed Article Abstract Computed tomography showed major abnormalities in 5.5%of the patients and follow up led to doubts about the initial clinical diagnosis in another 6%.Cumulative risk of recurrence was 40%at two years.The cumulative risk of recurrence at two years was 81%(95%confidence interval 66%to 97%)in patients with epileptic discharges on a standard or partial sleep deprivation electroencephalogram,39%(27%to 51%)in patients with other electroencephalographic abnormalities,and 12%(3%to 21%)in patients with normal electroencephalograms.Treatment was initiated in most patients who had one or more recurrences;40(70%)patients were completely controlled, eight(14%)had sporadic seizures,and nine(16%)did not become free of seizures within one year despite treatment.Conclusions-The decision to initiate or delay treatment should be based on electroencephalographic findings.

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