Short- and long-term outcomes of immediate and delayed treatment in epilepsy diagnosed after one or multiple seizures.

Affiliation

Sharma S(1), Chen Z(2), Rychkova M(3), Dunne J(4), Lee J(5), Lawn N(6), Kwan P(7).
Author information:
(1)Department of Neurosciences, Central Clinical School, Monash University, Alfred Hospital, The Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004, Australia. Electronic address: [Email]
(2)Department of Neurosciences, Central Clinical School, Monash University, Alfred Hospital, The Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004, Australia; Department of Medicine, The University of Melbourne, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC 3050, Australia; School of Public Health and Preventive Medicine, Monash University, 533 St Kilda Road, Melbourne, VIC 3004, Australia. Electronic address: [Email]
(3)Department of Medicine, The University of Melbourne, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC 3050, Australia. Electronic address: [Email]
(4)School of Medicine, Royal Perth Hospital Unit, University of Western Australia, Victoria Square, Perth, WA 6000, Australia; WA Adult Epilepsy Service, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA 6009, Australia. Electronic address: [Email]
(5)WA Adult Epilepsy Service, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA 6009, Australia. Electronic address: [Email]
(6)WA Adult Epilepsy Service, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA 6009, Australia. Electronic address: [Email]
(7)Department of Neurosciences, Central Clinical School, Monash University, Alfred Hospital, The Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004, Australia; Department of Medicine, The University of Melbourne, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC 3050, Australia; School of Public Health and Preventive Medicine, Monash University, 533 St Kilda Road, Melbourne, VIC 3004, Australia. Electronic address: [Email]

Abstract

OBJECTIVES: To compare the outcomes between immediate and deferred treatments in patients diagnosed after one or multiple (two or more) seizures. METHODS: Our observational study investigated seizure recurrence and 12-month seizure remission in patients with newly diagnosed epilepsy, comparing immediate to deferred treatment in patients diagnosed after one seizure or after two or more seizures. RESULTS: Of 598 patients (62% male, median age 39 years), 347 (58%) were treated at diagnosis and 251 (42%) received deferred or no treatment. Seizure recurrence was higher with deferred treatment both in patients diagnosed after two or more seizures (n = 363; adjusted hazard ratio [aHR] = 2.38, 95% confidence interval [CI]: 1.79-3.14, p < 0.001) and after one seizure (n = 235; aHR = 1.41, 95% CI: 0.995-1.99, p = 0.05). Cumulative seizure recurrence rates at two years in patients diagnosed after two or more seizures were 73% with deferred treatment and 49% with immediate treatment (risk-factor-corrected number-needed-to-treat [NNT] = 4), and in those diagnosed after one seizure the rates were 60% and 51% (NNT = 8). Of 380 patients with eligible follow-up (median 4.3 years), 287 (76%) had been in seizure remission for at least one year and 211 (56%) remained in remission at last follow-up. Long-term remission rates were similar between immediate and deferred treatments, and between patients diagnosed after one seizure and those with two or more seizures. SIGNIFICANCE: Immediate rather than deferred treatment was less likely to influence seizure recurrence in patients diagnosed with epilepsy after a single seizure than in those diagnosed after two or more seizures, and showed no differences in long-term seizure freedom.