Deciding when to treat epilepsy

Seizures are more likely to recur in patients with focal (partial) seizures, epileptiform abnormalities on EEG, abnormal neurological examination or a lesion on neuroimaging. In these situations, consider starting treatment after the first seizure.

When deciding whether to treat with drugs, the severity of the seizure and the patient's circumstances (eg employment, hobbies, driving) and preferences are considered.

Prophylactic use of antiepileptic drugs in situations associated with a high risk of epilepsy (eg traumatic brain injury, brain tumours or brain surgery) is not recommended.

See specific advice on treating:

• childhood and juvenile absence epilepsies
• juvenile myoclonic epilepsy
• Lennox-Gastaut syndrome and other symptomatic generalised epilepsies
• focal (partial) epilepsies
• tonic-clonic seizures where generalised or focal (partial) onset is unclear
• West syndrome (infantile spasms)
• neonatal seizures
• febrile seizures
• benign childhood epilepsy with centrotemporal spikes.