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Prescribing of medication after single seizure 'does not effect long-term outcome'

16 June, 2005

Giving
anti-epileptic drugs immediately to people with single or infrequent
seizures does not reduce their risk of further seizures in the
long-term, according to new research published in The Lancet.

The
study's authors also found that delaying medication did not increase
the risk of epilepsy in this group of people. The risks and benefits of
starting or withholding anti-epileptic drug treatment in patients with
few or infrequent seizures are unclear.

Between 1993 and 2000, researchers, led by Professor David Chadwick of the University of Liverpool,
recruited around 1,400 people with single or infrequent seizures. Half
of the group started with immediate treatment with anti-epileptic drugs
and the other half had their treatment deferred and received no drugs
until they and their doctor agreed treatment was necessary. Immediate
treatment reduced the chances of further seizures in the short-term but
had no effect on the long-term situation. More patients in the
immediate treatment group than in the deferred group experienced side
effects that were probably related to the treatment. There was no
difference in quality of life between the two groups.

Professor Chadwick concluded:

'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 anti-epileptic drugs, mainly
with carbamazepine or valproate, reduces the occurrence of seizures in
the next one to two years, but does not modify rates of long-term
remission after a first or after several seizures. At two 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.'