Results Published in Controlled Trial of Early Versus Delayed Treatment of Seizures

By Adam Modzelesky
EpilepsyUSA staff
Posted: November 16, 2005

The results of a study published in the June 11 issue of the medical journal The Lancet report that immediate antiepileptic drug treatment reduces the occurrence of seizures in the next one to two years, but does not affect long-term remission in individuals with single or infrequent seizures.

Anthony Marson, M.D., of the University of Liverpool in England, led the study which involved 1,443 participants with single seizures and early epilepsy; 722 patients were assigned immediate treatment with antiepileptic drugs and 721 were assigned deferred treatment. Of those who deferred treatment, 332 eventually began taking anticonvulsant medication.

Overall, 48 percent (693 of the 1443) of patients went on to have a seizure, 43 percent in the immediate treatment group and 53 percent in the delayed treatment group. Over time, many patients who initially started therapy tapered off medication and many who were in the group that did not take medication at first chose to go on medication. So that, by the 5-year mark, 60 percent of the group who chose immediate treatment were still taking anticonvulsant drugs and 41 percent of those who delayed immediate treatment had chosen to take anticonvulsant medication.

The time to the first and second seizures after entering the trial was significantly delayed in those taking medications compared to those delaying the start of medications. For those having a single seizure before entering the trial, the two year remission rate was the same for both groups at four years. For those who had a few seizures before entering the trial, the percentages who had been free of seizures for two years was the same by six years.

By five years, the percentage of patients in each group who had been seizure free for the past two years was almost identical, 76 percent as opposed to 77 percent. Interestingly, 61 percent of those in the early treatment group reported no side effects during the study, which was almost the same as the 69 percent of those in the deferred treatment group who reported no side effects.

What is one to conclude from this study? Actually there are many conclusions.

Marson wrote, "We have shown that a policy of immediate treatment with antiepileptic 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."

The group who started a medication early, however, always had a larger percentage of people who had no additional seizures at each stage of the study.

This study confirmed previous research which has shown that the chance of having a second seizure is about 50 percent.

"What this study has shown is that in the long run, people who choose to wait and see if they will have a second seizure before starting medication will probably have the same chance at long-term remission from seizures than if they went on medication immediately," said Gregory L. Barkley, chair of the Epilepsy Foundation's professional advisory board. "For those who choose to start medication after the first seizure, the risk of additional seizures in the next two years will be reduced by medication and they are quite likely to being free of troubling side effects by taking a single drug."