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

Sameer Sharma; Zhibin Chen; Maria Rychkova; John Dunne; Judy Lee; Nicholas Lawn; Patrick Kwan

doi:10.1016/j.yebeh.2021.107880

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

Epilepsy Behav. 2021 Apr:117:107880. doi: 10.1016/j.yebeh.2021.107880. Epub 2021 Mar 9.

Authors

Sameer Sharma¹, Zhibin Chen², Maria Rychkova³, John Dunne⁴, Judy Lee⁵, Nicholas Lawn⁶, Patrick Kwan⁷

Affiliations

¹ Department of Neurosciences, Central Clinical School, Monash University, Alfred Hospital, The Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004, Australia. Electronic address: [email protected].
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 protected].
³ Department of Medicine, The University of Melbourne, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC 3050, Australia. Electronic address: [email protected].
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 protected].
⁵ WA Adult Epilepsy Service, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA 6009, Australia. Electronic address: [email protected].
⁶ WA Adult Epilepsy Service, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA 6009, Australia. Electronic address: [email protected].
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 protected].

PMID: 33711683
DOI: 10.1016/j.yebeh.2021.107880

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.

Keywords: Deferred treatment; Recurrence; Seizure-remission.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Anticonvulsants / therapeutic use
Epilepsy* / drug therapy
Epilepsy* / therapy
Female
Humans
Male
Recurrence
Seizures / drug therapy
Seizures / therapy
Time-to-Treatment*

Substances

Anticonvulsants