RT Journal Article
SR Electronic
T1 Treatment of first tonic–clonic seizure does not affect mortality: long-term follow-up of a randomised clinical trial
JF Journal of Neurology, Neurosurgery & Psychiatry
JO J Neurol Neurosurg Psychiatry
FD BMJ Publishing Group Ltd
SP 924
OP 927
DO 10.1136/jnnp.2010.240069
VO 82
IS 8
A1 Maurizio A Leone
A1 Roberto Vallalta
A1 Alessandra Solari
A1 Ettore Beghi
A1 for the FIRST Group
YR 2011
UL http://jnnp.bmj.com/content/82/8/924.abstract
AB 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–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 0.2–21.5) 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% (91–97) at 10 years and 91% (87–95) at 20 years in treated patients and 100%, 98% (95–100), 97% (94–99) and 89% (85–94), 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–clonic seizure or only after seizure recurrence did not affect survival over the following 20 years.