ANTIEPILEPTIC DRUG-THERAPY IN YOUNGER PATIENTS - WHEN TO START, WHEN TO STOP

Decisions about whether and bow long to treat seizures in children and adolescents should be on rational criteria and knowledge of the natur al history of epileptic syndromes, rather than on the presumption that all seizures should be treated at any cost. Prospective studies of ch ildren with a first unprovoked seizure suggest that the risk of recurr ence is low and depends primarily on the etiology. In idiopathic seizu res, abnormal electroencephalographic findings and a family history of epilepsy are valuable predictors of recurrence. In seizures associate d with an identifiable brain pathology (''remote symptomatic seizures' '), predictors of recurrence include a partial seizure and a history o f febrile seizures. Status epilepticus presenting as a first seizure d oes not increase th risk of seizure recurrence. Most children with a s ingle unprovoked seizure do not require long-term antiepileptic drug ( AED) therapy, since fewer than 50% will develop recurrent seizures (ep ilepsy). Most children and adolescents with epilepsy will become seizu re-free with appropriate AED treatment. Recent studies suggest that AE Ds can be discontinued successfully in many after a seizure-free inter val of 2 years.