Treatment of children with "ordinary" epilepsy

Many children with epilepsy have a relatively benign clinical course with e ventual remission of their seizures and no further need for medication. It is not easy to be sure who these children are at the time of diagnosis, but they do not have catastrophic epilepsy. Epilepsy is best defined as two un provoked seizures. Not all of these children require treatment and treatmen t is motivated by fear of brain damage, injury, death, kindling of addition al seizures, and social consequences. None of these fears provides an absol ute indication for treatment. The decision to start medication should be co nsidered on an individual basis. The choice of a first AED is arbitrary wit h most AEDs having equal efficacy. Follow-up schedules have not been well s tudied. However, there is fairly convincing evidence that routine blood and urine screening for toxicity is of no benefit, if the child is asymptomati c. Serum drug levels are of little clear benefit. Once the child has been s eizure-free for 6 months to 12 months, it is reasonable to consider stoppin g medication. Only rarely does seizure control fail to return if there are recurrences without medication.