The benefits of antiepileptic drug treatment are among the best quantified of any area of epilepsy management, because of the number and quality of randomized controlled trials, systematic reviews, and meta-analyses that address these issues. It is evident that there are groups of readily identified patients at higher risk of seizure recurrence for whom the benefits of early drug treatment in preventing short-term seizure recurrence may be attractive for individual patients, although for the majority of patients at lower risk, benefit is minimal. It is now possible to exclude any modification of the long-term prognosis for patients arising from early treatment.