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Scientific article
Open access
English

Antiseizure medication ≤48 hours portends better prognosis in new‐onset epilepsy

Published inEuropean journal of neurology, vol. 31, no. 2, e16107
Publication date2023-10-27
First online date2023-10-27
Abstract

Background

Several studies found that patients with new‐onset epilepsy (NOE) have higher seizure recurrence rates if they presented already prior seizures. These observations suggest that timing of antiseizure medication (ASM) is crucial and should be offered immediately after the first seizure. Here, we wanted to assess whether immediate ASM is associated with improved outcome.

Methods

Single‐center study of 1010 patients (≥16 years) who presented with a possible first seizure in the emergency department between 1 March 2010 and 1 March 2017. A comprehensive workup was launched upon arrival, including routine electroencephalography (EEG), brain computed tomography/magnetic resonance imaging, long‐term overnight EEG and specialized consultations. We followed patients for 5 years comparing the relapse rate in patients treated within 48 h to those with treatment >48 h.

Results

A total of 487 patients were diagnosed with NOE. Of the 416 patients (162 female, age: 54.6 ± 21.1 years) for whom the treatment start could be retrieved, 80% (333/416) were treated within 48 h. The recurrence rate after immediate treatment (32%; 107/333) was significantly lower than in patients treated later (56.6%; 47/83; p < 0.001). For patients for whom a complete 5‐year‐follow‐up was available ( N = 297, 123 female), those treated ≤48 h ( N = 228; 76.8%) had a significantly higher chance of remaining seizure‐free compared with patients treated later ( N = 69; 23.2%; p < 0.001).

Conclusions

In this retrospective study, immediate ASM therapy (i.e., within 48 h) was associated with better prognosis up to 5 years after the index event. Prospective studies are required to determine the value of immediate workup and drug therapy in NOE patients.

eng
Keywords
  • EEG
  • MRI
  • Anti-epileptic drugs
  • Antiseizure medication
  • First seizure
  • Long-term EEG
  • New-onset epilepsy
  • Psychogenic
  • Sleep EEG
Citation (ISO format)
MENETRE, Eric et al. Antiseizure medication ≤48 hours portends better prognosis in new‐onset epilepsy. In: European journal of neurology, 2023, vol. 31, n° 2, p. e16107. doi: 10.1111/ene.16107
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Identifiers
ISSN of the journal1351-5101
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Technical informations

Creation12/04/2023 2:48:40 PM
First validation03/06/2024 1:49:44 PM
Update time03/06/2024 1:49:44 PM
Status update03/06/2024 1:49:44 PM
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