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INVITED COMMENTARIES
Year : 2006  |  Volume : 54  |  Issue : 4  |  Page : 350-351

Managing the first seizure: Sharing the decision with the patient result in better care


Bombay Hospital Institute of Medical Sciences, Mumbai - 400 020, India

Correspondence Address:
Nadir Bharucha
Bombay Hospital Institute of Medical Sciences, Mumbai - 400 020
India
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Source of Support: None, Conflict of Interest: None


PMID: 17114836

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How to cite this article:
Bharucha N. Managing the first seizure: Sharing the decision with the patient result in better care. Neurol India 2006;54:350-1

How to cite this URL:
Bharucha N. Managing the first seizure: Sharing the decision with the patient result in better care. Neurol India [serial online] 2006 [cited 2019 Nov 20];54:350-1. Available from: http://www.neurologyindia.com/text.asp?2006/54/4/350/28100


Antiepileptic drugs (AED) prevent seizure recurrence but treatment does not necessarily improve long term prognosis, i.e., patients treated early do not necessarily have a better chance of entering remission say at 5 years than those not treated early.[1] AED can suppress seizure discharges but may not avert epileptogenesis. Also, after the first unprovoked seizure the chances of having a 2nd seizure are much less if there is no structural brain lesion or abnormal EEG.

In this study these principles were utilized to counsel patients about the risks of seizure recurrence and benefits and side effects of AED.[2] At 1 year, seizure recurrence occurred more often in the treated group possibly because of poor compliance. Both groups were equally satisfied. A limitation of this study is that EEG abnormalities were not used to identify those at higher risk. Also, as with all epidemiological studies it should be borne in mind that the findings are most applicable to the group which has been studied, in this case, patients presenting to a government tertiary health care centre within a month of their 1st generalized tonic clonic seizure. There are two important considerations, the time interval between first seizure and time of registration and the type of seizure. In general, the longer the time interval the less the likelihood of seizure recurrence as the majority of seizure recurrences occur early.[3] Secondly, generalized tonic clonic seizures were the only type of seizure accepted for this study. Simple or complex partial and myoclonic seizures have a higher recurrence risk. Such cases are under represented in "first seizure" studies as patients usually have several of these before presenting to the clinician.[4]

Keeping these considerations in mind this study is probably the first of its kind in India and shows how sharing evidence based knowledge with patients can result in patient satisfaction.

 
  References Top

1.Marson A, Jacoby A, Johnson A, Kim L, Gamble C, Chadwick D, et al . Immediate versus deferred antiepileptic drug treatment for early epilepsy and single seizures: A randomized controlled trial. Lancet 2005;365:2007-13.  Back to cited text no. 1    
2.Chandramoulesswaran V, Dhanaraj M, Rangaraj R, Vengatesan A. Patients' preferences towards antiepileptic drug therapy following first attack of seizure. Neurol India 2006;52:387-9.  Back to cited text no. 2    
3.Hauser WA, Rich SS, Annegers JF, Anderson VE. Seizure recurrence after a 1st unprovoked seizure: An extended follow-up. Neurology 1990;40:1163-70.  Back to cited text no. 3    
4.Pohlmann-Eden B, Beghi E, Camfield C, Camfield P. The first seizure and its management in adults and children. BMJ 2006;332:339-42.  Back to cited text no. 4    




 

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Online since 20th March '04
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