L. Zacharowicz et Sl. Moshe, ANTIEPILEPTIC DRUG-THERAPY IN YOUNGER PATIENTS - WHEN TO START, WHEN TO STOP, Cleveland Clinic journal of medicine, 62(3), 1995, pp. 176-183
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.