Education And Debate

Controversies in Management: Do anticonvulsants alter the natural course of epilepsy? Treatment should be started as early as possible

BMJ 1995; 310 doi: (Published 21 January 1995) Cite this as: BMJ 1995;310:176
  1. E H Reynolds, consultant neurologista
  1. a Centre for Epilepsy, Maudsley Hospital, London SE5 8AZ

    Throughout this century the pharmacological treatment of epilepsy has been based on the Jacksonian concept, reinforced after Berger's discovery of the electroencephalograph, that seizures represent neuronal discharges that need to be suppressed by antiepileptic drugs. According to this view, when antiepileptic drugs are withdrawn seizures may be expected to recur unless the seizure disorder has gone into spontaneous remission, which apparently happens in a high percentage or cases.1

    A more recent view, which has some neglected historical roots,2 suggests that antiepileptic drugs may also influence the natural history of epilepsy, that epilepsy should be viewed as a process that has the potential to develop into an intractable disorder, and that early effective treatment may reduce this risk of chronicity.3 4

    Clinical studies

    Epilepsy used to be thought of as a chronic disorder in most patients, but recent community and hospital based studies of newly diagnosed patients have shown that only …

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