Early treatment of first seizure

A common dilemna for primary care physicians and neurologists is what to do with patients after their first seizure. Some will never have a never seizure, while others will progress to full-blown epilepsy. There is no sure way to tell the difference. There have been some theoretical reasons to suspect early treatment might prevent progression to epilepsy, but this speculation is largely based on animal data.

A study in a recent issue of Lancet (June 11th, Marson et al) suggests no such protective effect. More than 1400 patients with recent onset of seizures (most had 1 or 2 total) were randomized to an anti-seizure medication or no treatment (i.e. it was not placebo controlled).

As expected, early treatment with anti-seizure meds decreased the number of the seizures in the short term, but, perhaps suprisingly, had no effect on progression to chronic epilepsy, with about 2/3 of each group being seizure free for a prolonged period 5 years after randomization. As the accompanying editorial points out, however, avoiding seizures in the short-term is no small accomplishment as seizures can cause signficant harm if they occur while, say, driving.