Jhe Joumai of Emergency Medicme, VOI ! 1, pp 787-793, 1993 Printed ,n the USA Copyrlgh! B ‘993 Sei~&wn Press Ltd.

MIZED CLINICAL TRIAL ON THE EFFI- CACY OF ANTIEPILEPTIC DRUGS IN REDUCING THE RISK OF RELAPSE AFTER A FIRST UNPRO- VOKED TONIC-CLONIC SEIZURE. First Seizure Trial Group. Neurology. 1993;43:478-83.

The authors performed a randomized, multicenter, un- blinded clinical trial to assess the efficacy of treatment of the first unprovoked tonic-clonic seizure with antiepileptic drugs (AED’s). The study population was derived from all patients aged 2 years or more and seen within 7 days after a witnessed, unprovoked, tonic-clonic seizure with or with- out focal onset presenting to 35 hospitals in Italy. Patients were randomized to immediate treatment or to treatment only in the case of seizure recurrence. Patients assigned to treatment were given monotherapy with carbamazepine, phenytoin, phenobarbital, or sodium valproate at the pref- erence of their physician. Patients were excluded who had isolated partial seizures, more than one seizure in 24 hours, ‘were greater than 7 days postseizure, or had seizures secon- dary to an acute neurologic insult or metabolic disorder. Multiple variables regarding past medical history and type of seizures were recorded for each patient.

Out of 840 patients with a first seizure identified, 397 patients met all inclusion criteria. 204 were randomized to immediate treatment and 193 to treatment only in the event of seizure recurrence. During follow-up, one or more gen- eralized seizures occurred in 34 treated and 75 untreated patients. At al! follow-ups (1,3,6,12,18,24 months), the treated group had significantly fewer seizures than the un- treated group. Treatment of the first seizure was followed by a significant reduction in the risk of relapse from 51% to 25% at 2 years postrandomization. In conclusion, the authors state that treatment with AED’s leads to a signifi- cant reduction in the risk of seizure recurrence after a first unprovoked seizure. [DJ Safranek, MD]

Editor’s Comment: The resuhs of this study are provoca- tive, but the study was not blinded and there was no stan- dardized treatment regimen.

MPUTED TOMOGRAPHIC EVALUATION TO EXCLUDE UMATIC AORTIC DISRUPTION. Agee

CK, Metzler MH, Churchilli 1992;33:876-81.

it&e11 FL, J Trauma.

Of blunt trauma (BT) patients who the scene, 10% to 16% are found to ha disruption (TAD) as the cause of death. 8OV~ of patients with TAD don’t survive TAD results in 98% m reviews a trauma center TAD and the use of computed tornog~a~b~~ (CT) scarming as a valid way of excluding the diagnosis. 133 patients had abnormal CXR with BT and required evaluatiion for sus- pected aortic disruption. TAD was strongly suspected in 28 patients, and they had aortography primarily. 5 of 28 bad TAD. The other IO5 patients had CT first. 94 of 105 were considered negative by strict criteria ’ contrast enhancement, no artifacts, complete study S e riced CT radiologist, and no positive criteria). There were 2 ques- tionable or inadequate CT scans, an grams were negative. 9 patients showed posiiive CT criteria (mediastinal hematoma, false a~c~~ysrn~ ~rr~~~l~~ aortic contour, divided aortic lumen, or intimal flap). Of these 9 patients, 1 went directly to the 0 (where TAD was found), and 8 went on to a~t~riog~a~, where 6 had TAD diagnosed. No patient in the obse ion group had a missed TAD. They conclude that T can be excluded, and aortography avoided, in 90% o gestive CXR if set criteria are follo~i high quality CT scanning is a safe and reliable method to exclude TAD in BT victims. [SM Coffman, MD]

Editor’s Comment: CT is generally less time consuming than formal angiography.

Optic Neuritis Study Group. In this placebo-controlled, rnuIt~c~~t~~ study, the effects

of short-course use of glucocorticoi patients receiving steroids for optic neuritis. The 457 pa- tients were assigned to one of three study groups: intrave- nous methylp~ed~isolo~e for 3 dajrs ~~IIowed by oral pred- nisone for It days, oral pred~~so~~ for 14 days, or oral

Abstracts-designed to keep readers up to date by providing original abstracts of current hterature from all fields relating to emergency medicine-are prepared by the Emergency Medicine Residents of rhe

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