title: Prognosis in epilepsy: initiating long-term drug therapy.
abstract: BACKGROUND
  Prognosis in epilepsy refers to the probability of either achieving seizure remission (SR), whether spontaneously or using antiepileptic drugs (AED), or failing to achieve control of epileptic seizures (ES) despite appropriate treatment. Use of AED is recommended after a second unprovoked ES. For a first episode, the decision of whether or not to start drug treatment depends on the risk of recurrence and the advantages or disadvantages of the antiepileptic drug. The main goal of treatment is achieving absence of ES without adverse effects (AE). AED is selected according to epilepsy type and the demographic and clinical characteristics of the patient.
  
  
  METHODS
  A PubMed search located articles and recommendations by the most relevant scientific societies and clinical practice guidelines concerning epilepsy prognosis and treatment. Evidence and recommendations are classified according to the prognostic criteria of the Oxford Centre for Evidence-Based Medicine (2001) and the European Federation of Neurological Societies (2004) for therapeutic actions.
  
  
  CONCLUSIONS
  Most newly diagnosed epileptic patients achieve good control over their ES. The majority of the AEDs available at present provide effective control over all types of ES, and choice therefore depends on the patient's individual characteristics. Treatment should be initiated as monotherapy at the lowest effective dose, which in half of all patients provides ES control and is well tolerated. In cases in which the first AED is not effective, alternative therapy should be started, and monotherapy should be employed before combination therapy where possible. The probability of achieving good control over ES decreases with each successive treatment failure.
authors.affiliation: Servicio de Neurología, Hospital Regional Universitario Carlos Haya, Málaga, España. Electronic address: juanmercade@gmail.com.
authors.forename: J M
authors.initials: JM
authors.lastname: Mercadé Cerdá
authors.affiliation: Servicio de Neurología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.
authors.forename: J A
authors.initials: JA
authors.lastname: Mauri Llerda
authors.affiliation: Servicio de Neurología, Hospital Universitari Germans Trias i Pujol, Badalona, España.
authors.forename: J L
authors.initials: JL
authors.lastname: Becerra Cuñat
authors.affiliation: Servicio de Neurología, Clínica la Zarzuela, Madrid, España.
authors.forename: J
authors.initials: J
authors.lastname: Parra Gomez
authors.affiliation: Servicio de Neurología, Hospital Universitari Dr. Josep Trueta, Girona, España.
authors.forename: A
authors.initials: A
authors.lastname: Molins Albanell
authors.affiliation: Servicio de Neurología, Hospital Clínico, Universidad de Navarra, Pamplona, España.
authors.forename: C
authors.initials: C
authors.lastname: Viteri Torres
authors.affiliation: Servicio de Neurología, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, España.
authors.forename: F J
authors.initials: FJ
authors.lastname: López Gonzalez
authors.affiliation: Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España.
authors.forename: X
authors.initials: X
authors.lastname: Salas Puig
mesh_terms: D000927:Anticonvulsants / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D004827:Epilepsy / Q000188:drug therapy*; D019317:Evidence-Based Medicine; D006801:Humans; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012307:Risk Factors; D012640:Seizures / Q000517:prevention & control
chemical_list: D000927:Anticonvulsants
keywords: Clinical Practice Guidelines; Epilepsia; Epilepsy; Evidence-based medicine; Failure of first antiepileptic drug; Fracaso del primer fármaco antiepiléptico; Guía de Práctica Clínica; Inicio del tratamiento crónico; Medicina basada en la evidencia; Onset of long-term treatment; Prognosis; Pronóstico