Long-term outcome is unchanged by antiepileptic drug treatment after a first seizure: A 15-year follow-up from a randomized trial in childhood

Purpose: In 1989 we reported that I year of daily treatment with carbamazepine (CBZ) significantly reduced the recurrence rate after a first afebrile seizure in children compared with no treatment in a randomized open trial. We sought to determine if the long-term clinical course and rate of remission were changed by treatment starting after the first seizure. Methods: Participants of the original trial (14 CBZ. 17 no medication) were contacted in 2001. Results: Sixteen controls and 10 CBZ (84%) cases were followed LIP for 15 years. After randomization and follow-up. 12 controls and five treated patients had at least one more seizure (p = NS). For those with recurrences, the number of recurrences appeared to be the same in both groups. Number of medications used was also the same. Terminal remission (greater than or equal to2 years seizure free with or without medication) was achieved by eight (80%) of 10 CBZ and 14 (88%) of 16 controls. and terminal remission off medication in six (60%) of 10 CBZ (p = NS). Conclusions: Based on this small study with long follow-up, it appears that for children treated with CBZ after a first seizure, the subsequent clinical Course and remission rates are not improved in comparison with a no-treatment strategy. Delaying treatment after a first seizure appears defensible.