The efficacy of treatment in relation to the lost time “tiempo perdido” in a group of 3529 epileptic patients was evaluated in the Division of Neurology and Clinical Neurophysiology, Hospital General du Cataluna, Barcelona, Spain. The mean follow-up period was ten years. The “lost time” is the period elapsed from the onset of symptoms and the beginning of long-term anticonvulsant treatment. In 970 patients with a lost time of less than a year, 86% were seizure-free whereas in 922 patients whose treatment was delayed greater than 11 years, 64% were seizure-free. Delay in starting anticonvulsant medication influenced the success of drug withdrawal. Of 710 patients who discontinued treatment, 315 (44%) had treatment initiated within one year of onset of seizures whereas drug withdrawal was possible in only 106 (15%) of the group in which treatment was delayed over 11 years. A total of 144 (20%) patients had seizure recurrences after drug withdrawal and of this number, 14% occurred in the group treated early and 41% in the group with the longest period of delay in treatment. [1]
COMMENT. The sooner the correct diagnosis of epilepsy is made and treatment is begun, the fewer seizures a patient will suffer, and the greater the likelihood of successful antiepileptic control and subsequent withdrawal of antiepileptic drugs. Gowers, in 1881, pointed out that seizures beget seizures, and the greater the number of epileptic seizures the greater the likelihood of their continued reoccurrence. The results of this study should caution those who advocate delays in the initiation of anticonvulsant therapy and should encourage a more vigorous attempt to prevent seizure recurrences after the first epileptic seizure.