Antiepileptic drug therapy in younger patients: when to start, when to stop
Leon Zacharowicz, MA, MD
Solomon L. Moshé, MDAddress reprint requests to S.L.M., Laboratory of Developmental Epilepsy, Albert Einstein College of Medicine, Rose F. Kennedy Center, Room 316, 1410 Pelham Parkway South, Bronx, NY 10461.
Decisions about whether and how long to treat seizures in children and adolescents should be based on rational criteria and knowledge of the natural history of epileptic syndromes, rather than on the presumption that all seizures should be treated at any cost.KEY POINTS
Prospective studies of children with a first unprovoked seizure suggest that the risk of recurrence is low and depends primarily on the etiology. In idiopathic seizures, abnormal electroencephalographic findings and a family history of epilepsy are valuable predictors of recurrence. In seizures associated with an identifiable brain pathology (“remote symptomatic seizures”), predictors of recurrence include a partial seizure and a history of febrile seizures. Status epilepticus presenting as a first seizure does not increase the risk of seizure recurrence.
Most children with a single unprovoked seizure do not require long-term antiepileptic drug (AED) therapy, since fewer than 50% will develop recurrent seizures (epilepsy).
Most children and adolescents with epilepsy will become seizure-free with appropriate AED treatment. Recent studies suggest that AEDs can be discontinued successfully in many after a seizure-free interval of 2 years.