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Delaying Epilepsy Drugs May Be OK for Some

Immediate Treatment May Not Be Needed After First Epilepsy Seizure

WebMD Health News

June 9, 2005 -- Starting epilepsy drugs right away may not be necessary for people who have experienced a first seizure or who are in the early stages of epilepsy.

Researchers found that immediate treatment with epilepsy drugs did not reduce the risk of repeat seizures over the long term in a large group of people followed for five years.

"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," write researcher David Chadwick of the University of Liverpool, England, and colleagues.

Researchers say the decision of when to begin treatment for someone who has suffered a first seizure or has infrequent seizures is a difficult one and these results should help doctors and patients make informed choices. Epilepsy drugs have side effects, and a first-time seizure does not always mean that the person will develop lifelong epilepsy.

Weighing the Benefits of Epilepsy Drugs

In the study, researchers compared the effects of immediate treatment with epilepsy drugs vs. delayed treatment in a group of more than 1,400 people who had had one seizure or were in the early stages of epilepsy with infrequent seizures.

Half of the participants received immediate treatment with epilepsy drugs, primarily Tegretol and valproate, and the other half did not receive epilepsy drugs until they and their doctor agreed that treatment was necessary.

The results appear in the June 11 issue of The Lancet.

The study showed that immediate treatment with epilepsy drugs did reduce the number of seizures in the first two years of treatment, but not without side effects, including fatigue, drowsiness, and nausea.

But the study also showed that virtually the same number of patients who were treated immediately with epilepsy drugs and those who delayed treatment were seizure-free for three to five years after the start of the study (76% of the immediately treated patients vs. 77% of those who delayed treatment).

There was also no difference in the quality of life reported by both treatment groups.

Little Short-Term Benefit

In an editorial that accompanies the study, Samuel Berkovic of the University of Melborne in Melborne, Australia, says the findings should help doctors and patients make better decisions about when to start epilepsy treatment.

Apart from a decreased risk of seizures in the short term, the results of this study show there is little to gain in the long term from starting medication immediately, writes Berkovic.

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