Department of Neurology

Too quick to medicate?

Q: Is it wise to start medication for a patient who lost consciousness twice on one day. The spell was first preceeded by a possible aura of deja vu and sadness, followed by "weird" feeling. However, all blood tests, MRIs, and EEGs (mulitple) were "normal."

A: The issue of whether to treat or not after a first seizure is still debated, and the reasons are complex. The reasons to begin medications immediately are to prevent further spells that could be dangerous, and for the possibility that untreated seizures may lead to an uncontrollable state. The reasons not to treat immediately include uncertainty of diagnosis, the possibility that they may not recur, and the risks of exposure to any medication. As a result, physicians are often divided in this situation.

There may also be other factors that favor treating immediately. If there is any evidence of past spells, it would infer that a recurrent seizure disorder exists. For example, many persons with new onset of seizures recall having similar "auras" in the past, without loss of consciousness. In fact, auras are actually seizures, and their presence in the past would make your doctor more inclined to treat you.

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