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The Pharmaceutical Journal
Vol 274 No 7354 p752
18 June 2005

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No long-term benefit for early treatment in epilepsy

Early treatment of epilepsy does not reduce the risk of seizure recurrence in the long term, say UK researchers.

Study treatment

Of the 722 patients assigned to immediate treatment, 328 (46 per cent) received carbamazepine, 325 (46 per cent) received valproate, 25 (3 per cent) received phenytoin and 19 (3 per cent) received lamotrigine.

Of the 721 patients assigned to deferred treatment, 332 patients went on to start treatment during the course of the trial.

On average, 50 per cent of people do not experience a recurrence after their first seizure and deciding when to begin treatment can be difficult. To address this question, the researchers assigned just over 1,400 patients who had experienced single or infrequent seizures to either immediate treatment with antiepileptics or to deferred treatment (see Panel).

“After 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,” said David Chadwick, department of neurological science, University of Liverpool, and one of the study authors.

Immediate treatment delayed time to first seizure, second seizure and first tonic-clonic seizure (hazard ratios 1.4 [95 per cent confidence interval 1.2–1.7], 1.3 [1.1–1.6] and 1.5 [1.2–1.8], respectively). It also reduced the time taken to achieve two years of remission (P=0.023). However, by five years there was little difference between seizure outcomes (Lancet 2005;365:2007).