Singular seizures, including acute symptomatic seizures (ASSs), most often do not require immediate medication administration, as they are rather short and self-limiting (eg, tonic-clonic seizures). However, temporary administration of benzodiazepines is often chosen to reduce the risk of short-term seizure repetition (eg, IV or oral lorazepam 1-2.5 mg or oral clobazam 5-10 mg as single doses or for a few days). In certain scenarios of ASSs, when seizure recurrences are considered likely, a standard antiseizure drug is selected (see Status Epilepticus).
While classic substances are still in use (phenytoin, valproic acid), modern drugs have more favorable adverse effect profiles (eg, levetiracetam or lacosamide). However, in the setting of ASSs, antiseizure treatment shall be conceptualized and discussed as a transient treatment lasting a few weeks or months (as opposed to epilepsy treatment). Discussion with a seizure specialist is helpful.
When confronted with acute seizures, one needs to consider the presence of potential precipitating factors or acute illness (see Table 12.3-1).