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Neurology India, Vol. 54, No. 4, October-December, 2006, pp. 350-351 Invited Commentaries Managing the first seizure: Sharing the decision with the patient result in better care Bharucha Nadir Bombay Hospital Institute of Medical Sciences, Mumbai - 400 020 Code Number: ni06124 Antiepileptic drugs (AED) prevent seizure recurrence but treatment does not necessarily improve long term prognosis, i.e., patients treated early do not necessarily have a better chance of entering remission say at 5 years than those not treated early.[1] AED can suppress seizure discharges but may not avert epileptogenesis. Also, after the first unprovoked seizure the chances of having a 2nd seizure are much less if there is no structural brain lesion or abnormal EEG. In this study these principles were utilized to counsel patients about the risks of seizure recurrence and benefits and side effects of AED.[2] At 1 year, seizure recurrence occurred more often in the treated group possibly because of poor compliance. Both groups were equally satisfied. A limitation of this study is that EEG abnormalities were not used to identify those at higher risk. Also, as with all epidemiological studies it should be borne in mind that the findings are most applicable to the group which has been studied, in this case, patients presenting to a government tertiary health care centre within a month of their 1st generalized tonic clonic seizure. There are two important considerations, the time interval between first seizure and time of registration and the type of seizure. In general, the longer the time interval the less the likelihood of seizure recurrence as the majority of seizure recurrences occur early.[3] Secondly, generalized tonic clonic seizures were the only type of seizure accepted for this study. Simple or complex partial and myoclonic seizures have a higher recurrence risk. Such cases are under represented in "first seizure" studies as patients usually have several of these before presenting to the clinician.[4] Keeping these considerations in mind this study is probably the first of its kind in India and shows how sharing evidence based knowledge with patients can result in patient satisfaction. References
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