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Child's first unprovoked seizure "should not be treated as epilepsy" - report

29 January, 2003

A new practice guideline developed by the American Academy of Neurology and the Child Neurology Society recommends that doctors avoid routinely treating a child's first unprovoked seizure with anti-epileptic drugs (AEDs).

The guideline, issued to doctors in the United States and published in the journal Neurology, explains that it used to be common practice to treat an "unprovoked" seizure (or one not caused by serious head trauma, or an infection, or other known cause) with AEDs. However, researchers and child neurologists now believe that there may be risks of chronic daily treatment with AEDs that could be more detrimental to the child's health or development than seizure recurrence. The report authors say that the risks and benefits of treatment must be individualised.

Approximately 25,000 to 40,000 children experience a first unprovoked seizure each year in the United States. According to a lead author of the guidelines, about 1 per cent of all children will develop epilepsy, defined as two or more incidents of unprovoked seizures.

Dr Deborah Hirtz, a child neurologist and director for clinical trials at the National Institute of Neurological Disorders and Stroke in Bethesda, Maryland said that before any treatment decisions are made, it's important to determine whether the event is truly a seizure, and if it's the child's first:

"Carefully reviewing the child's medical history may rule out any unrecognized prior seizures and a neurological exam can indicate if there are any abnormalities that increase the risk for developing epilepsy".

Most children with a first unprovoked seizure will have few or no recurrences, according to the guidelines, and about 10 per cent will have 10 or more seizures despite therapy.