[When should long-term treatment of epilepsy be started].
It becomes more and more difficult to decide whether to treat a patient who has had a first seizure. Information obtained from retrospective and prospective analysis of the natural history of epilepsy, the risk of a second crises occurring and the studies showing that the morbidity from seizure is less than previously postulated, raise questions about the decision to treat. In this study, we analyze the various factors involved in making the decision as to when to start long-term treatment of epilepsy. These include: confirmation of the seizure, the risk of recurrence, the type of crisis, etiology, age of onset, value of the electroencephalogram, classification of the syndrome, predisposing or favourable factors, the duration on the crises and the characteristics of the patients, as well as the evaluation in each case of the risk or benefit to be expected from this treatment. It is again emphasized that two or more crises should have occurred, before the diagnosis of epilepsy is established. In childhood, there is a general tendency to treat, when there are no negative factors or features which indicate a poor prognosis. However, in adults the decision is not so clear, and each case has to be decided individually and the best treatment agreed by the patient and his doctor. Finally, it is important that the patient's family have diazepam available, in case another seizure occurs.
Campistol
J
J
Servei de Neurologia, Hospital Sant Joan de Déu-Clinic, Hospital Universitari Sant Joan de Deu, Barcelona, España.
D017668:Age of Onset; D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use*; D004827:Epilepsy / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence
D000927:Anticonvulsants
Cuándo debe iniciarse el tratamiento antiepiléptico crónico.