Early Versus Delayed Initiation of Antiseizure Medication Following a First Unprovoked Seizure in Adults: A Randomised Controlled Trial

Author(s):Hassan R, Brennan C, Petrova S, Kim J, Adeyemi O

Received: 2019-06-27 Accepted: 2019-07-15 Published: 2019-07-27

Abstract

Background: Whether to initiate antiseizure medication (ASM) after a first unprovoked seizure to prevent seizure recurrence remains controversial, balancing efficacy against medication burden and side effects.
Objective: To compare 24-month seizure recurrence rates between adults randomised to immediate ASM initiation versus watchful waiting following a first unprovoked seizure.
Methods: A multicentre, open-label, randomised controlled trial enrolled 620 adults aged 18–70 years presenting within 72 hours of a first unprovoked seizure. Participants were randomised 1:1 to immediate lamotrigine (n=310) or watchful waiting (n=310) and followed for 24 months.
Results: Seizure recurrence at 24 months occurred in 26.8% of the immediate-treatment group versus 45.2% of the watchful-waiting group (HR 0.54; 95% CI 0.42–0.70; p<0.001). Health-related quality of life scores were significantly better in the treatment group at 12 months. Adverse events were mostly mild and transient.
Conclusion: Immediate ASM initiation after a first unprovoked seizure significantly reduces seizure recurrence and improves quality of life at 24 months compared with watchful waiting.

Keywords: Versus, Antiseizure, Medication, Unprovoked Seizure

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