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Response to First Treatment May Predict Epilepsy's Course
Date:5/9/2012

to the first medication tried often predicted how a patient might respond to additional medications. Half responded to the first medication tried and became seizure-free.

For those who had to take a second drug, either alone or in combination with another drug, 13 percent became seizure-free. When a third drug had to be tried, just 4 percent became seizure-free. By the fifth drug tried, less than 1 percent became seizure-free.

Overall, 37 percent of those trying medications became seizure-free immediately. Another 22 percent became seizure-free within six months of starting treatment.

Sixteen percent had what's known as relapsing-remitting seizures. After being seizure-free for a year or more, they had as many as five periods of seizure relapse.

Twenty-five percent never became seizure-free, according to the study.

"Given that epilepsy can be controlled with medications in the majority of patients -- nearly 70 percent -- a lack of response should call for re-evaluation for conditions other than epilepsy," Kwan said, adding that if you haven't responded to the first two drugs your doctor tries, you should be seen by a physician at a specialized epilepsy center for non-drug treatments.

Dr. Cynthia Harden, chief of the division of epilepsy and electroencephalography at the Cushing Neuroscience Institute in Great Neck, N.Y., agreed. "Most people do well on the first or second drug. Some people need a combination to become seizure free. But, if someone fails monotherapy and combination therapy, it's time to think about options other than drugs," she said.

"Surgery, for the right patient, is the only disease-altering treatment. It can stop seizures completely," she explained, and added that a newer technique called laser-ablation therapy can also be helpful.

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