Chapter 17 - Does Early Treatment Influence the Long-Term Outcome of Epilepsy?

Abstract

This chapter focuses primarily on data from epidemiological studies and randomized controlled trials that have addressed prognosis and outcome for patients with single seizures and early epilepsy. For patients with a single seizure or early epilepsy, when compared to deferred treatment, immediate treatment with one of the current firstline antiepileptic drugs reduces the risk of seizure recurrence, but has no impact on the longer-term seizure outcome in epilepsy. Consensus holds that antiepileptic drug treatment should be initiated for the majority of patients who have had two or more seizures, as the risk of recurrence is high, although the aim of treatment is to control seizures rather than influence the natural history of epilepsy. For patients with a single seizure, the recurrence risk is generally low, and there is a trade-off between preventing seizures and adverse effects of antiepileptic drugs such that neither policy is associated with overall quality-of-life gains. Patients can be identified at a low, medium, and high risk of seizure recurrence to aid patients and clinicians in discussions regarding the pros and cons of starting antiepileptic drug treatment following a single seizure.