@article {Leone924, author = {Maurizio A Leone and Roberto Vallalta and Alessandra Solari and Ettore Beghi and for the FIRST Group}, title = {Treatment of first tonic{\textendash}clonic seizure does not affect mortality: long-term follow-up of a randomised clinical trial}, volume = {82}, number = {8}, pages = {924--927}, year = {2011}, doi = {10.1136/jnnp.2010.240069}, publisher = {BMJ Publishing Group Ltd}, abstract = {Background Information on the effects of early treatment of seizures on mortality is scarce. The authors assessed the survival of patients with a first generalised tonic{\textendash}clonic seizure, randomised to immediate treatment (treated) versus treatment only in the event of seizure recurrence (untreated), over a 20-year period.Methods The authors followed 419 patients. The median follow-up was 19.7 years (range 0.2{\textendash}21.5) for a total of 7867 person-years.Results 40 persons (9.6\%) died during follow-up, 19 (8.9\%) treated and 21 (10.3.\%) untreated. The probability of surviving was 100\% at 1 year, 97\% (95\% CI 95\% to 99\%) at 5 years, 94\% (91{\textendash}97) at 10 years and 91\% (87{\textendash}95) at 20 years in treated patients and 100\%, 98\% (95{\textendash}100), 97\% (94{\textendash}99) and 89\% (85{\textendash}94), respectively, in untreated patients (p=0.7). After adjustment for treatment of first seizure and putative risk factors (gender, age, seizure type, previous uncertain seizures, family history of seizures, pre-, peri- and postnatal risk factors, remote aetiological factors for epilepsy, abnormal neurological examination, CT or MRI abnormalities, EEG abnormalities and acute treatment), only the presence of aetiological factors for epilepsy predicted a higher mortality (HR 3.4, 95\% CI 2.5 to 4.3\%; p\<0.01). Patients with remote aetiological factors and who did not achieve 5-year remission had the poorest survival.Conclusion Starting antiepileptic treatment immediately after the first generalised tonic{\textendash}clonic seizure or only after seizure recurrence did not affect survival over the following 20 years.}, issn = {0022-3050}, URL = {https://jnnp.bmj.com/content/82/8/924}, eprint = {https://jnnp.bmj.com/content/82/8/924.full.pdf}, journal = {Journal of Neurology, Neurosurgery \& Psychiatry} }