The Quality Standards Subcommittee of the AAN and Practice Committee of the CNS have reviewed published literature to determine when to begin treatment after a first unprovoked seizure, risk of recurrence, prevention of recurrence, development of chronic epilepsy, and side effects of AEDs. Treatment after a first unprovoked seizure decreases the risk of a second seizure but does not alter the prognosis for long-term seizure remission. The majority of patients will have few or no recurrences, and only 10% have more than 10 recurrences regardless of therapy. Cognitive and behavioral side effects of AEDs may occur, particularly with phenobarbital. Treatment is not indicated for the purpose of preventing epilepsy; it may be considered when the benefits of reducing the risk of a second seizure outweigh the risks of educational and psychosocial side effects. Decision to treat should be individualized and based on patient and family preferences as well as medical issues. Future research should focus on prevention and cure of the underlying disorder. 
COMMENT. The early identification of patients likely to develop epilepsy after a first seizure, the underlying causes for the poor prognosis, and the development of more specific treatments without side effects are the aims of future epilepsy research. Virological and immunological factors have been invoked in some epilepsies, notably Rasmussen’s encephalitis.