Controversies in Management: Do anticonvulsants alter the natural course of epilepsy? Treatment should be started as early as possible

Reynolds, E. H.

doi:10.1136/bmj.310.6973.176

Cited by 45 publications

(19 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the other 2 cohorts [24,37] , single-seizure cases were less than a third of the cohort. This supports the evidence that for some patients, the rate of seizure recurrence increases with increasing number of seizures [42][43][44] .…”

Section: Immediate Remissionsupporting

confidence: 75%

The Influence of Design and Definition on the Proportion of General Epilepsy Cohorts with Remission and Intractability

Abimbola

Martiniuk²,

Hackett³

et al. 2011

Neuroepidemiology

View full text Add to dashboard Cite

Remission while on anti-epileptic drug (AED) therapy and remission off AED are the only prognostic criteria defined by the International League against Epilepsy (ILAE), defining remission as 5 seizure-free years. Prognosis studies in epilepsy have investigated other prognostic categories using different designs and definitions. This systematic review explores factors that explain discrepancies in the proportion of patients reported with commonly studied prognostic categories in general epilepsy cohorts. Thirty publications (reporting 37 studies) were included. The outcome categories were classified as immediate remission (5 studies), remission off medication (7 studies), remission on or off medication (15 studies), intractability (9 studies) and no remission after relapse (1 study). The findings show the importance of qualifying estimates specifically by how they were defined in each study, study design, setting and patient population as these have implications for patient management and counselling. The ILAE should define the outcome measures and terminology to which researchers should be required to adhere in subsequent updates of their guidelines on research related to remission and intractability.

show abstract

Section: Immediate Remissionsupporting

confidence: 75%

The Influence of Design and Definition on the Proportion of General Epilepsy Cohorts with Remission and Intractability

Abimbola

Martiniuk²,

Hackett³

et al. 2011

Neuroepidemiology

View full text Add to dashboard Cite

show abstract

“…It has been suggested that the failure to control seizures early in the illness renders epilepsy more resistant to treatment in the future, perhaps because of structural changes in the brain. 17,[41][42][43][44][45] An equally consistent explanation would be that epilepsy in any individual patient has an inherent severity and response to treatment and that severely affected patients are difficult to control from early in their condition. 46 -51 Overall, early treatment did not have a positive impact on prognosis; this probably reflects selection (earlier treatment in patients with more severe disease) or another bias.…”

Section: Discussionmentioning

confidence: 99%

Factors predicting prognosis of epilepsy after presentation with seizures

et al. 2000

View full text Add to dashboard Cite

The objective of this study was to identify the factors, at the time of diagnosis, that determine the prognosis for remission of epilepsy. A prospective community‐based cohort study of 792 patients recruited at the time of their first diagnosis of epileptic seizures was undertaken; in those classified 6 months after presentation, the median follow‐up period was 7.2 years (quartiles at 6.2 and 8.2 years) after presentation. We analyzed data from 6 months after the first identified seizure, which prompted the dianosis of epilepsy, to allow us to factor in those aspects contingent on a diagnostic assessment. Baseline clinical and demographic data were analyzed using the Cox proportional hazards regression model with remission of epilepsy for 1, 2, 3, and 5 years as outcome measures. The dominant clinical feature predicting remission was the number of seizures in the 6‐month diagnostic assessment period. Thus, the chance of entering 1 year of remission by 6 years for a patient who had 2 seizures during this initial 6 months was 95%; for 5 years of remission, it was 47% as opposed to 75% for 1 year of remission and 24% for 5 years of remission if there had been 10 or more seizures during this period. The number of seizures in the early phase of epilepsy (here, taken as the first 6 months after presentation) is the single most important predictive factor for both early and long‐term remission of seizures. Ann Neurol 2000;48:833–841

show abstract

“…47,50 -52 The decision to treat should therefore be made on the grounds that the patient has had a sufficient number of events to justify therapy and not with the hope of somehow preventing the development of "chronic" epilepsy. 53 Although the probability of a seizure recurrence seems to be the same in children and adults, the relative risks and benefits of AED therapy, which take account of not only the statistical probability of further seizures but also the possible consequences of another seizure and the potential adverse effects of AED therapy, are quite different in children than in adults. 45,46,54 …”

Section: When Is Treatment With Aeds Indicated?mentioning

confidence: 98%

Predictors of multiple seizures in a cohort of children prospectively followed from the time of their first unprovoked seizure

et al. 2000

View full text Add to dashboard Cite

Controversies in Management: Do anticonvulsants alter the natural course of epilepsy? Treatment should be started as early as possible

Cited by 45 publications

References 7 publications

The Influence of Design and Definition on the Proportion of General Epilepsy Cohorts with Remission and Intractability

The Influence of Design and Definition on the Proportion of General Epilepsy Cohorts with Remission and Intractability

Factors predicting prognosis of epilepsy after presentation with seizures

Predictors of multiple seizures in a cohort of children prospectively followed from the time of their first unprovoked seizure

Contact Info

Product

Resources

About