Long-Term Outcome Is Unchanged by AED Treatment after a First Seizure: Follow-Up from a Randomised Trial in Childhood.
Abstract number :
2.213
Submission category :
Year :
2001
Submission ID :
130
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
C.S. Camfield, MD, Pediatrics, Dalhousie University, Halifax, NS, Canada; P.R. Camfield, MD, Pediatrics, Dalhousie University, Halifax, NS, Canada; S.W. Smith, MD, Pediatrics, Dalhousie University, Halifax, NS, Canada; J.M. Dooley, MB, Pediatrics, Dalhous
RATIONALE: In 1989 we reported that one year of daily treatment with carbamazepine (CBZ) significantly reduced the recurrence rate after a first afebrile seizure in children compared with no treatment in a randomised open trial. We undertook this study to determine if the long-term clinical course and rate of remission was changed by AED treatment starting after the first seizure.
METHODS: Participants of the original trial (14 CBZ, 17 no medication) were contacted in 2001.
RESULTS: 16 controls and 10 CBZ (84%) cases were followed for 15 years. Distribution of epilepsy syndromes was the same in both groups and included Juvenile Myoclonic Epilepsy (JME) 2, Benign Epilepsy of Childhood with Centro-temporal Spikes 3, cryptogenic partial 16 and symptomatic partial 5. After randomisation and throughout follow-up, 12 (75%) controls and 5 (50%) treated patients had at least one more seizure (p=ns). For those with recurrences, the number of recurrences was the same in both groups excluding the one patient with JME who developed intractable seizures. Number of medications used was also the same. Terminal remission ([gt]2 yrs seizure free with or without medication) was achieved by 8/10 CBZ versus 14 /16 controls. Terminal remission off medication was achieved by 6/10 CBZ versus 11/16 controls (p=ns). In retrospect it was possible that 3 of the original patients actually had syncope.
CONCLUSIONS: When patients are treated with carbamazepine after a first seizure, the subsequent clinical course and remission rate over 15 years is not improved in comparison with a no AED treatment strategy. Waiting for additional seizures before starting treatment is acceptable.