Multiple Unprovoked Seizures in 24 hours

[NeuroDocDO]

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What is your approach to the management of a patient with multiple unprovoked seizures in 24 hour period with normal MR brain imaging and routine EEG.

Do you recommend treatment or consider watchful waiting and repeat EEG with sleep deprivation and/or ambulatory as long as the patient is agreeable to not being on AED.

I found this article in Neurology which addresses this clinical scenario.

Please discuss.

 

[typhoonegator]

As you mention, I think it really depends on how the patient feels about it. A cluster of seizures might seem much scarier to a patient than just one, even if the data suggests that you can treat the cluster as one event. I would explain the data and offer them short-term AEDs while your workup is ongoing, as long as they knew the pluses and minuses of treatment and the relative lack of data supporting the decision to treat.

Obviously, if details of the seizure cluster are more consistent with partial or generalized status epilepticus (i.e. not a clear return to baseline between spells) then I would fall on the side of treatment during an urgent workup.