title: Treatment of first tonic-clonic seizure does not affect mortality: long-term follow-up of a randomised clinical trial.
abstract: BACKGROUND
  Information on the effects of early treatment of seizures on mortality is scarce. The authors assessed the survival of patients with a first generalised tonic-clonic seizure, randomised to immediate treatment (treated) versus treatment only in the event of seizure recurrence (untreated), over a 20-year period.
  
  
  METHODS
  The authors followed 419 patients. The median follow-up was 19.7 years (range 0.2-21.5) for a total of 7867 person-years.
  
  
  RESULTS
  40 persons (9.6%) died during follow-up, 19 (8.9%) treated and 21 (10.3.%) untreated. The probability of surviving was 100% at 1 year, 97% (95% CI 95% to 99%) at 5 years, 94% (91-97) at 10 years and 91% (87-95) at 20 years in treated patients and 100%, 98% (95-100), 97% (94-99) and 89% (85-94), respectively, in untreated patients (p=0.7). After adjustment for treatment of first seizure and putative risk factors (gender, age, seizure type, previous uncertain seizures, family history of seizures, pre-, peri- and postnatal risk factors, remote aetiological factors for epilepsy, abnormal neurological examination, CT or MRI abnormalities, EEG abnormalities and acute treatment), only the presence of aetiological factors for epilepsy predicted a higher mortality (HR 3.4, 95% CI 2.5 to 4.3%; p<0.01). Patients with remote aetiological factors and who did not achieve 5-year remission had the poorest survival.
  
  
  CONCLUSIONS
  Starting antiepileptic treatment immediately after the first generalised tonic-clonic seizure or only after seizure recurrence did not affect survival over the following 20 years.
authors.affiliation: SCDU Neurologia, AOU Maggiore della Carità, C.so Mazzini 18, 28100 Novara, Italy. maurizio.leone@maggioreosp.novara.it
authors.forename: Maurizio A
authors.initials: MA
authors.lastname: Leone
authors.forename: Roberto
authors.initials: R
authors.lastname: Vallalta
authors.forename: Alessandra
authors.initials: A
authors.lastname: Solari
authors.forename: Ettore
authors.initials: E
authors.lastname: Beghi
mesh_terms: D000293:Adolescent; D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012307:Risk Factors; D012640:Seizures / Q000188:drug therapy* / Q000401:mortality* / Q000503:physiopathology; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000927:Anticonvulsants