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It is widely agreed that after two or more seizures patients should be given antiepileptic treatment,but there is still controversy about the treatment of patients after a first unprovoked seizure.In a multicenter, randomized open trial,patients with a first tonic-clonic seizure were randomized to immediate treatment(carbamazepine,phenytoin.phenobarbital or sodium valproate)or to treatment only after another seizure.Fifty-two(24%) of the 215 patients randomized to immediate treatment and 85(42%)of the 204 randomized to delayed treatment experienced seizure recurrence during followup.Age,acute treatment of the seizure with benzodiazepines,remote etiologic factors,and EEG abnormalities were significant predictors of relapse.Of the immediately treated patients,87%had no seizures for a year and 68%had no seizures for two years,whereas only slightly fewer initially untreated patients(83%and 60%)achieved these endpoints.Patients treated after the first seizure and those treated after seizure relapse had the same time-dependent probability of achieving 1 and 2 seizure-free years. None of the variables that were prognostic predictors of relapse was significantly associated with the probability of having 1 or 2 years of seizure control.Anticonvulsants in patients presenting a first tonic- clonic seizure reduce the risk of relapse;however,50%of patients who are not treated with never experience a second seizure.Moreover,the probability of long term remission is not influenced by treatment of the first seizure. |
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anticonvulsants
prognosis
seizure
seizure,prognosis in adults
seizure,prognosis in childhood
seizure,treatment of
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treatment of neurologic disorder
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