Delaying epilepsy therapy shows little detriment
NEW YORK (Reuters Health) - Treatment with antiepileptic drugs following the onset of seizures can be delayed without affecting quality of life, according to a UK study.
"Apart from driving status, delaying treatment really didn't have any major negative effects in terms of quality of life," lead investigator Dr. Ann Jacoby, of the University of Liverpool, told Reuters Health.
"Research has shown that patients generally are increasingly reluctant to take medications of any kind," she added, "and in our study over a fifth of those who were randomized to taking antiepileptic drugs immediately told us they would have preferred not to."
As described in the journal Neurology, Jacoby's group analyzed survey responses from 331 patients two years after they had been assigned to immediate or delayed therapy for new-onset seizures.
Patients assigned to deferred treatment, say the investigators, were no more likely to report impairments in general health, cognitive function, psychological well-being, or social function.
However, UK driving regulations require a 12-month seizure-free period before issuance of a license, placing patients on delayed therapy at a disadvantage.
Aside from driving, the researchers point out that there were clear quality-of-life impacts from taking antiepileptic drugs and, to an even greater extent, from continuing seizures.
So, doctors need to discuss the pros and cons of treatment with people who develop seizures, reviewing "quality-of-life considerations with them carefully, as well as the clinical ones," Jacoby observed. This will give patients "the opportunity to think through the implications of either course of action for their own personal situation."
In an accompanying editorial, Dr. Barbara G. Vickrey of UCLA, Los Angeles, comments, "US neurologists are much more likely than their UK counterparts to treat even a single unprovoked seizure."
Therefore, she concludes, "Despite the strength of this study's findings, translating those findings into changes in practice that involve deferring therapy is likely to be much more difficult in the United States."
SOURCE: Neurology, April 10, 2007.
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