Scientists Advocate Delaying Medication For Early Epilepsy

Scientists investigating epilepsy at the University of Liverpool have found no significant long-term benefit in administering immediate treatment to those with early epilepsy and infrequent seizures.

Around 500,000 people in the UK suffer from epilepsy, making it the most common serious neurological condition. Many of those who develop epilepsy start having seizures during childhood, but it can develop at any age.

The risks and benefits of starting or withholding treatment for patients with few or infrequent seizures have always been unclear, but research now suggests that early treatment adds little if any benefit to a patient’s quality of life.

Professor David Chadwick and his team, from the University’s Division of Neuroscience, found that early treatment does not reduce their risk of seizure recurrence in the long-term and delaying medication does not increase their risk of chronic epilepsy.

The scientists, whose research is published in this week’s issue of The Lancet, conducted a randomised trial of 1,400 patients with single or infrequent seizures from around the world. Half were assigned to immediate treatment with antiepileptic drugs and half were assigned to deferred treatment, where they received no drug until they and their clinician agreed treatment was necessary.

The trial found that immediate treatment reduced short-term seizure recurrence but had no effect on long-term outcomes. More patients in the immediate treatment group than in the deferred group experienced adverse effects that were probably treatment related. There was no difference in quality of life between the two groups.

Professor Chadwick said: “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 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.

“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.”

Samuel Berkovic from the University of Melbourne, Australia, added: “Apart from a decreased risk of proximate seizures, the results of this study suggest there is little to gain in the long-term from starting medication immediately.”

“In what is often a difficult decision good data coupled with a clinical synthesis of the risks and benefits that are tailored to the patient’s personal circumstances will contribute to optimum treatment decisions.”