After a seizure, early intervention with anticonvulsant drugs appears to have little effect on the long-term prognosis of epilepsy, British researchers report in the June 11th issue of The Lancet.

“When to begin treatment with antiepileptic drugs in patients with few or infrequent seizures is a difficult decision,” study co-author Dr. David Chadwick, from the University of Liverpool, and his associates note. Doctors and patients must weigh the risk of seizure recurrence against the risk of medication side effects.

To further investigate how these decisions affect patients, the authors evaluated the outcomes of patients who had single seizures and early epilepsy whose doctors were uncertain whether to proceed with treatment. The researchers randomly assigned 722 patients to start treatment immediately and 721 to defer treatment until the doctors and patient agreed that treatment was necessary. In the deferred-treatment group, 332 started treatment during the course of the trial.

Patients who deferred treatment had a shorter time until the first or second recurrent seizure. However, the two groups did not differ in time to a fifth seizure. By the two-year follow-up, 32 percent of those in the immediate-treatment group had a recurrent seizure versus 39 percent of those in the deferred-treatment group.

There was no greater improvement in quality of life among those assigned to immediate treatment versus deferred treatment. Immediate treatment was associated with more adverse events that were believed to be treatment related.

After three years, 74 percent of the immediate-treatment group and 71 percent of the deferred-treatment group were seizure-free. At 5 years, 76 percent and 77 percent were seizure free.

Patients assigned to immediate treatment were more likely to express a preference for the alternative treatment policy than were those assigned to deferred treatment,” Dr. Chadwick and his colleagues report.

“Immediate treatment with antiepileptic drugs… does not modify rates of long-term remission after a first or after several seizures,” they conclude.

In a related commentary, Drs. Anne M. McIntosh and Samuel F. Berkovic, from the University of Melbourne in Victoria, Australia, point out that patients often prefer to forego immediate treatment because “regular antiepileptic medication is an acknowledgment and reminder of epilepsy, a condition that still has some stigma attached.”

The work by Dr. Chadwick’s group, they say, confirms that “delaying medication did not increase the risk of chronic epilepsy.”

SOURCE: The Lancet, June 11, 2005.