[Treatment of newly diagnosed epileptic crises. A French experience]

CAROLE is a prospective survey of 1942 children and adults presenting at least one unprovoked epileptic seizure first diagnosed between May 1 1995 and June 30 1996 by 243 French neurologists and neuropediatricians. In half these cases, the patient had already experienced more than one seizure at the time of diagnosis. Patients presenting only one seizure but either a case history or significant EEG or neuroimaging abnormalities suggestive of a high risk of recurrence were classified as cases of epilepsy. Drug treatment was prescribed to 73 p. 100 of the cohort. Treatment was far more frequent in cases where seizure had recurred (90 p. 100) than in cases of first seizure (54 p. 100) (p < 0.0001). In the latter category, the older the patients, the more likely they were to be treated (69 p. 100 of patients > or = 60 years old versus 49 p. 100 of those under 24 years of age, p = 0.001). Those with multiple onset were more often treated than those with single onset (48 p. 100 of cases of single seizure versus 80 p. 100 of clustered seizures and 90 p. 100 of status epilepticus, p < 0.0001), as were cases of complex partial seizure (68 p. 100 versus just under 50 p. 100 of cases of generalized seizure, p = 0.0001), those with epileptiform EEG abnormalities (67 p. 100 of cases of cryptogenic partial epilepsy and 63 p. 100 of idiopathic generalized epilepsy versus 42 p. 100 of isolated seizure, p < 0.0001) and those with cerebral lesions visible by neuroimagery (89 p. 100 of cases of symptomatic partial epilepsy). The decision not to treat was generally based on clinical signs of non-gravity. Understandably, cases of idiopathic partial epilepsy were less treated than other syndromes, 22 p. 100 in the group of first seizure patients, 67 p. 100 in the group where seizure had recurred before diagnosis. A single-drug therapy was recommended to 1389 of the 1411 patients treated, in 63 p. 100 of cases sodium valproate, in 30 p. 100 carbamazepine. These data reveal not only the attitude to treatment of the specialists concerned, but also the desires or refusals of patients or patients' parents. The present study was limited to this question of treatment or no treatment. A further study will be necessary to investigate to what extent patients followed the treatment prescribed and how these cases evolved.