CLINICAL COURSE OF UNTREATED TONIC-CLONIC SEIZURES IN CHILDHOOD - PROSPECTIVE, HOSPITAL-BASED STUDY

Objective: To assess decleration and acceleration in the disease proce ss in the initial phase of epilepsy in children with new onset tonic-c lonic seizures. Study design:Hospital based follow up study. Setting: Two university hospitals, a general hospital, and a children's hospita l in the Netherlands. Patients: 204 children aged 1 month to 16 years with idiopathic or remote symptomatic, newly diagnosed, tonic-clonic s eizures, of whom 123 were enrolled at time of their first ever seizure ; all children were followed until the start of drug treatment (78 chi ldren), the occurrence of the fourth untreated seizure (41 children), or the end of the follow up period of two years (85 untreated children ). Main outcome measures: Analysis of disease pattern from first ever seizure. The pattern was categorised as decelerating if the child beca me free of seizures despite treatment being withheld. In cases with fo ur seizures, the pattern was categorised as decelerating if successive intervals increased or as accelerating if intervals decreased. Patter ns in the remaining children were classified as uncertain. Results: A decelerating pattern was found in 83 of 85 children who became free of seizures without treatment. Three of the 41 children with four or mor e untreated seizures showed a decelerating pattern and eight an accele rating pattern. In 110 children the disease process could not be class ified, mostly because drug treatment was started after the first, seco nd,or third seizure. The proportion of children with a decelerating pa ttern (42%, 95% confidence interval 35% to 49%) may be a minimum estim ate because of the large number of patients with an uncertain disease pattern. Conclusions: Though untreated epilepsy is commonly considered to be a progressive disorder with decreasing intervals between seizur es, a large proportion of children with newly diagnosed, unprovoked to nic-clonic seizures have a decelerating disease process. The fear that tonic-clonic seizures commonly evolve into a progressive disease shou ld not be used as an argument in favour of early drug treatment in chi ldren with epilepsy.