TY - JOUR
T1 - Short- and long-term outcomes of immediate and delayed treatment in epilepsy diagnosed after one or multiple seizures
AU - Sharma, Sameer
AU - Chen, Zhibin
AU - Rychkova, Maria
AU - Dunne, John
AU - Lee, Judy
AU - Lawn, Nicholas
AU - Kwan, Patrick
PY - 2021/4
Y1 - 2021/4
N2 - 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.
AB - 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.
KW - Deferred treatment
KW - Recurrence
KW - Seizure-remission
UR - http://www.scopus.com/inward/record.url?scp=85102118948&partnerID=8YFLogxK
U2 - 10.1016/j.yebeh.2021.107880
DO - 10.1016/j.yebeh.2021.107880
M3 - Article
C2 - 33711683
AN - SCOPUS:85102118948
SN - 1525-5050
VL - 117
JO - Epilepsy and Behavior
JF - Epilepsy and Behavior
M1 - 107880
ER -