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pills in handMay 11 2016

Initiating antiepileptic drug therapy in someone who has had a first unprovoked seizure may not always be the best option, a Cochrane review has proposed.

Initiating an antiepileptic after a single unprovoked seizure appears to reduce the risk of a subsequent seizure. High quality evidence indicated there was a lower probability of seizure at a year and at five years, and a higher probability of five-year remission of seizures, said the researchers.

However, there was no evidence that antiepileptic treatment affected the overall mortality of epilepsy, and treatment of the first seizure “was associated with a significantly higher risk of adverse events.” In addition, “there is moderate quality evidence that immediate treatment may result in more side effects than delayed treatment, but it is unclear if immediate treatment results in more side effects than placebo or no treatment.”

The findings are drawn from a review of six studies, covering data from 1,634 participants, including those who had received immediate drug treatment after their first seizure. Primary outcomes were seizure recurrence and immediate remission for five years.

Among the secondary findings were that the median time to a second seizure occurring was 736 days in the control group, and 1,165 in patients who had been initiated on treatment after their first seizure. Two of the studies had also included reporting on deaths, but showed that time to death was not different between those initiated on antiepileptics and those in the control group.

“The decision to start antiepileptic drug treatment following a first seizure still remains a controversial issue,” said the researchers. “indiscriminate treatment following a first unprovoked seizure is not warranted, since the risk of recurrence must be balanced against the likelihood to attain five-year remission during the follow-up and the possible harm of drugs given for a long-lasting period.

“Adverse events associated with antiepileptic drugs are a particular concern for children, women considering pregnancy, pregnant women, and the elderly. Therefore, the decision to start antiepileptic drug treatment following a first unprovoked seizure should be individualized and based on patient preference, clinical, legal, and socio-cultural factors.”

Links:

Cochrane review

MA Leone. Immediate antiepileptic drug treatment, versus placebo, deferred, or no treatment for first unprovoked seizure. Cochrane Database of Systematic Reviews. Published online May 6 2016

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