EPILEPSY IN CHILDHOOD - AN AUDIT OF CLINICAL-PRACTICE

Background: It is not known how many children with epilepsy may not ne ed treatment with antiepileptic drugs (AEDs), how many respond unsatis factorily to subsequent treatment regimens, and how many achieve ''acc eptable control'' despite lack of remission. Methods: In a prospective multicenter hospital-based study, 494 children with a broad range of seizure types and types of epilepsy were followed up for at least 2 ye ars. There was no standard treatment protocol. We describe the treatme nt strategies applied to these children by the neurologists in charge and outcome with respect to remission from seizures. Results: Treatmen t was initially withheld in 29% of the children, and after 2 years 17% still had not received any AEDs. There were no serious complications caused by withholding treatment. Of the children treated with AEDs, 60 % were still using the first AED after 2 years; 80% received monothera py and 20%, polytherapy. Children with severe symptomatic epilepsies, such as the West or Lennox-Gastaut syndrome, received polytherapy earl y on in the course of treatment. When 3 regimens had failed, the chanc e of achieving a remission of more than 1 year with subsequent regimen s was 10%. Nevertheless, 15 of 50 children receiving AEDs in whom the ''longest remission ever'' was less than 6 months did achieve acceptab le seizure control according to the neurologist in charge of treatment . Hence, of 494 children, only 35 (7%) developed an intractable form o f epilepsy, defined as failure to bring seizures under acceptable cont rol. Conclusions: A substantial percentage of children with new-onset epilepsy did not need treatment with AEDs. Chances of achieving a good outcome declined with subsequent treatment regimens. Not all children with recurrent seizures were suffering from intractable epilepsy; som e had achieved acceptable control of seizures.