Giving individuals with single or infrequent seizures immediate treatment does not reduce their risk of seizure recurrence in the long-term

Giving individuals with single or infrequent seizures immediate treatment does not reduce their risk of seizure recurrence in the long-term, suggests a randomised trial published in this week’s issue of The Lancet.

The authors also found that delaying medication did not increase the risk of chronic epilepsy in this group of people.

The risks and benefits of starting or withholding antiepileptic drug treatment in patients with few or infrequent seizures are unclear.

Between 1993 and 2000, David Chadwick (University of Liverpool, UK) and colleagues, recruited around 1400 patients with single or infrequent seizures from centres in the UK and around the world. Half the individuals were assigned to immediate treatment with antiepileptic drugs and half were assigned to deferred treatment, where they received no drug until they and their clinician agreed treatment was necessary. Immediate treatment reduced short-term seizure recurrence but had no effect on long-term outcomes. More patients in the immediate treatment group than in the deferred group experienced adverse effects that were probably treatment related. There was no difference in quality of life between the two groups.

Professor Chadwick concludes: "We have sought to quantify precisely benefits in terms of seizure control, to improve the quality of information available to support clinicians and patients in making decisions about treatment options . . . We have shown that a policy of immediate treatment with antiepileptic drugs, mainly with carbamazepine or valproate, reduces the occurrence of seizures in the next 1–2 years, but does not modify rates of longterm remission after a first or after several seizures. At 2 years, the benefits of improved seizure control with immediate treatment seem to be balanced by the unwanted effects of drug treatment and there is no improvement in measures of quality of life."

In an accompanying CommentSamuel Berkovic (University of Melborne, Australia) states: "Apart from a decreased risk of proximate seizures, the results of this study suggest there is little to gain in the long-term from starting medication immediately."

He adds: "In what is often a difficult decision good data coupled with a clinical synthesis of the risks and benefits that are tailored to the patient’s personal circumstances will contribute to optimum treatment decisions."