Should anticonvulsants be initiated after a single unprovoked seizure in a patient with normal EEG, imaging, and neuro exam?

Initiating anticonvulsant therapy after a single unprovoked seizure in a patient who has a normal EEG, imaging studies, and a neuro exam is generally not necessary. Current clinical guidelines suggest that most patients with a single unprovoked seizure and no significant findings on neurologic evaluation or imaging studies have a low risk of recurrence. The decision to start medication is typically influenced by the presence of risk factors for seizure recurrence.

In the absence of any identifiable abnormalities, it is often preferable to observe the patient rather than initiate treatment. This approach can help avoid unnecessary medication exposure, which can have side effects and potential complications. Therefore, the correct response reflects the understanding that the management of a single unprovoked seizure with a normal workup favors observation over immediate treatment.