IMMEDIATE VERSUS DELAYED AED THERAPY FOR NEW ONSET EPILEPSY: IMPLICATIONS FOR QUALITY OF LIFE
Abstract number :
1.284
Submission category :
Year :
2003
Submission ID :
1798
Source :
www.aesnet.org
Presentation date :
12/6/2003 12:00:00 AM
Published date :
Dec 1, 2003, 06:00 AM
Authors :
Ann Jacoby, Carrol Preston, Julie Doughty, David Chadwick Department of Primary Care, University of Liverpool, Liverpool, United Kingdom; Centre for Health Services Research, University of Newcastle, Newcastle upon Tyne, United Kingdom; Department of Neur
The question of whether to treat new-onset seizures immediately or to delay starting treatment is a vexed one, both clinically and with regard to quality of life (QOL) issues. Immediate treatment may optimise QOL by preventing further seizures; conversely, it may reduce QOL by exposing affected individuals unnecessarily to the potential harms associated with AED therapy. Documentation of the QOL benefits and harms of these alternative management strategies is, therefore, crucially important.
The UK MRC Study of Early Epilepsy and Single Seizures is the largest randomised study to date of treatment for new onset seizures and epilepsy. 1443 patients were recruited worldwide over an eight-year period, and randomised to immediate or delayed treatment with AEDs. The QOL profiles of patients in each randomised group were tracked using validated self-completion questionnaires mailed at baseline and 2 and 4 years following randomisation. The questionnaires comprised a battery of measures addressing physical, psychological and social domains of QOL. 441 eligible adults returned a baseline questionnaire, of whom 331 also returned one at two years. This analysis relates to 262 individuals who returned questionnaires within a specified timeframe.
Treatment policy was unrelated to observed changes over the 2-year follow-up in physical status (general health, symptoms, physical function); psychological status (worry about seizures, levels of anxiety and depression, self-esteem, mastery, stigma) and social function (social activities and restrictions, employment status). However, changes in all three QOL domains were associated with both seizure and drug status at two years. Patients generally expressed happiness with the treatment policy to which they were allocated, but a higher proportion of those randomised to immediate treatment expressed concerns about their treatment allocation.
These QOL data provide more complete information for both clinicians and patients and so can aid their decision-making about optimal management for new onset seizures.
[Supported by: The UK Medical Research Council]