A new study has offered evidence that the immediate use of antiepileptic drug (AED) therapy may not always be the best option when treating people who have experienced a first, unprovoked epileptic seizure.
During the study, which was conducted at San Giovanni Rotondo in Italy, researchers collated data from six randomised controlled trials that investigated the effects of AED treatment versus no AED treatment of first seizures in adults and children. They used this information to assess the likelihood of seizure recurrence, seizure remission, death and adverse effects in people who receive treatment, compared to those who do not.
The findings, published in the Cochrane Database of Systematic Reviews, suggest that people who receive treatment after a first seizure have a lower probability of relapse after one year and five years, and that they have a higher probability of an immediate five-year remission.
However, there appears to be no significant advantage of treatment with regards to the overall chance of achieving a five-year remission period, and there is also no evidence that taking AEDs reduces the overall risk of mortality.
The results also indicate that, compared to an approach where therapy is deferred, treatment of a first seizure is associated with a significantly higher risk of adverse events, and therefore that prescribing an AED could carry risks that outweigh the potential benefits.
The research concludes: “Treatment of the first unprovoked seizure reduces the risk of a subsequent seizure, but does not affect the proportion of patients in remission in the long-term. Antiepileptic drugs are associated with adverse events, and there is no evidence that they reduce mortality.
“In light of this review, the decision to start antiepileptic drug treatment following a first unprovoked seizure should be individualised and based on patient preference, clinical, legal and socio-cultural factors.”
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