A Cochrane review included 6 studies with a total of 1634 subjects. Two of the studies recruited adults, one children and 3 others recruited both adults and children. All patients were randomised within 2 weeks of their first seizure in 3 studies, and 70% of the patients were randomised within 2 months in one study. Three studies included only generalized tonic-clonic seizures and the others included both generalized and partial seizures. Patients were allocated to the intervention group (n = 816) and to the control group (n = 818), which was divided between deferred treatment (n = 606), placebo (n = 113), or no treatment (n = 99). For the two largest studies data were available for individual participant meta-analysis. Compared to controls, participants randomised to immediate treatment had a lower probability of relapse at one year (RR 0.49, 95% CI 0.42 to 0.58; 6 trials, n = 1634), at 5 years (RR 0.78; 95% CI 0.68 to 0.89; 2 trials, n = 1212) and a higher probability of an immediate 5-year remission (RR 1.25; 95% CI 1.02 to 1.54; 2 trials, n = 1212). However there was no difference between immediate treatment and control in terms of 5 year remission at any time (RR 1.02, 95% CI 0.87 to 1.21; 2 trials, n = 1212). Antiepileptic drugs did not affect overall mortality after a first seizure (RR 1.16; 95% CI 0.69 to 1.95; 2 trials, n = 1212). Compared to deferred treatment (RR 1.49, 95% CI 1.23 to 1.79; 2 trials, n = 1212), treatment of the first seizure was associated with a significantly higher risk of adverse events. There was an association of adverse events and treatment of the first seizure vs. no treatment or placebo (RR 14.50, 95% CI 1.93 to 108.76; one trial, n = 118) and (RR 4.91, 95% CI 1.10 to 21.93; one trial, n = 228), respectively.
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