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 1 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 up 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 (>2 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.