The decision whether or not to recommend chronic antiepileptic drug treatment for a child with seizures requires a risk-benefit analysis tailored to each individual case. Because all of the available antiepileptic medications have some potential adverse effects, the analysis may weigh in favor of a decision not to treat. Three clinical scenarios in pediatrics in which the no-treatment option may often be appropriate include a single unprovoked seizure, febrile seizures, and benign focal epilepsy of childhood. (J Child Neurol 1994;9(Suppl);2S8-2S13).
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References
1.
Camfield PR, Camfield CS, Dooley JM, et al: Epilepsy after a first unprovoked seizure in childhood. Neurology1985;35: 1657-1660.
2.
Camfield CS , Camfield PR: Initiating drug therapy, in Wyllie E (ed):The Treatment of Epilepsy: Principles and Practice . Philadelphia, Lea & Febiger , 1993, pp 791-797.
3.
Maytal J., Shinnar S., Moshé SL, Alvarez LA: Low morbidity and mortality of status epilepticus in children. Pediatrics1989; 83:323-331.
4.
Shinnar S., Berg AT, Moshé SL, et al: The risk of recurrence following a first unprovoked seizure in childhood: A prospective study. Pediatrics1990;85:1076-1085.
5.
Annegers JF, Shirts SB, Hauser WA, Kurland LT: Risk of recurrence after an initial unprovoked seizure. Epilepsia1986;27: 43-50.
6.
Hauser WA, Anderson VE, Loewenson RB, McRoberts SM: Seizure recurrence after a first unprovoked seizure. N Engl J Med1982;307:522-528.
7.
Hopkins A., Farman A., Clarke C.: The first seizure in adult life: Value of clinical features, electroencephalography, and computerized tomographic scanning in prediction of seizure recurrence . Lancet1988;1:721-726.
8.
Consensus Development Conference on Febrile Seizures: Proceedings . Epilepsia1981;2:377-381.
9.
Freeman JM: The best medicine for febrile seizures. N Engl J Med1993;327:1161-1162.
10.
Freeman JM, Vining Epg: Decision making and the child with febrile seizures. Pediatr Rev1992; 13:298-304.
11.
Nelson KB, Ellenberg JH: Predictors of epilepsy in children who have experienced febrile seizures . N Engl J Med1976;295: 1029-1033.
12.
Annegers JF , Hauser WA, Shirts SB, Kurland LT: Factors prognostic of unprovoked seizures after febrile convulsions. N Engl J Med1987 ;316:493-498.
13.
Ounsted C., Lindsay J., Norman R.: Biological Factors in Temporal Lobe Epilepsy. Clinics in Developmental Medicine No. 22. London, William Heinemann, 1966 .
14.
Falconer MA : Surgical treatment of sequelae of severe febrile convulsions, in Brazier MAB, Coceani F (eds): Brain Dysfunction in Infantile Febrile Convulsions . New York, Raven Press , 1976, pp 307-326.
15.
Abou-Khalil B. , Andermann E., Andermann F., et al: Temporal lobe epilepsy after prolonged febrile convulsions: Excellent outcome after surgical treatment. Epilepsia1993;34:878-883.
16.
Nelson KB: Can treatment of febrile seizures prevent subsequent epilepsy? in Nelson KB, Ellenberg JH (eds): Febrile Seizures. New York , Raven Press, 1981, pp 143-145.
17.
Maytal J., Shinnar S.: Febrile status epilepticus. Pediatrics1990 ; 86:611-616.
18.
Farwell JR, Lee YJ, Hirtz DG, et al: Phenobarbital for febrile seizures—effects on intelligence and on seizure recurrence. N Engl J Med1990 ;322:364-369.
19.
Committee on Drugs: Behavioral and cognitive effects of anticonvulsant therapy. Pediatrics1985;76:644-647.
Knudsen FU: Recurrence risk after a first febrile seizure and effect of short term diazepam prophylaxis. Arch Dis Child1985;60:1045-1049.
22.
Rosman NP: The case for treating febrile seizures. Contemp Pediatr1992;9:12-34.
23.
Rosman NP, Colton T., Labazzo J., et al: A controlled trial of diazepam administered during febrile illnesses to prevent recurrence of febrile seizures. N Engl J Med1993;329:79-84.
24.
Fischbein CA , Berg IJ: Diazepam to prevent febrile seizures, letter . N Engl J Med1993;329:2033.
25.
Leiner S.: Diazepam to prevent febrile seizures, letter. N Engl J Med1993;329:2033.
26.
Berg AT: Diazepam to prevent febrile seizures, letter. N Engl J Med1993;329:2033.
27.
Camfield P. , Camfield C.: Diazepam to prevent febrile seizures, letter . N Engl J Med1993;329:2034.
28.
Rosman NP, Colton T., Labazzo J.: Diazepam to prevent febrile seizures, letter. N Engl J Med1993;329:2034.
29.
Loiseau P.: Benign focal epilepsies of childhood, in Wyllie E (ed): The Treatment of Epilepsy: Principles and Practice. Philadelphia, Lea & Febiger, 1993, pp 503-512.
30.
Lüders H., Lesser RP, Dinner DS, Morris HH: Benign focal epilepsy of childhood, in Liiders H, Lesser RP (eds): Epilepsy: Electroclinical Syndromes. Berlin, Springer-Verlag, 1987, pp 303-346.
31.
Loiseau P., Beaussart M.: The seizures of benign childhood epilepsy with rolandic paroxysmal discharges . Epilepsia1973; 14:381-389.
32.
Loiseau P., Duche B., Cordova S., et al: Prognosis of benign childhood epilepsy with centro-temporal spikes: A follow-up study of 168 patients. Epilepsia1988;29:229-235.
33.
Lehrman P.: Benign partial epilepsy with centro-temporal spikes, in Roger J, Dravet C, Bureau M, et al (eds): Epileptic Syndromes in Infancy, Childhood, and Adolescence. London, John Libbey Eurotext, 1985, pp 150-158.
34.
Beaussart M. , Faou R.: Evolution of epilepsy with rolandic paroxysmal foci: A study of 324 cases. Epilepsia1978 ;19: 337-342.
35.
Blom S., Heijbel J.: Benign epilepsy of children with centrotemporal EEG foci: A follow-up study in adulthood of patients initially studied as children. Epilepsia1982;23:629-631.
36.
Commission on Classification and Terminology of the International League Against Epilepsy: Proposal for revised classification of epilepsies and epileptic syndromes. Epilepsia1989;26: 268-278.
37.
Dalla-Bernardina B., Chiamenti C., Capovilla G., Colamaria V.: Benign partial epilepsies in childhood, in Roger J, Dravet C, Bureau M, et al (eds): Epileptic Syndromes in Infancy, Childhood, and Adolescence. London, John Libbey Eurotext, 1985 , pp 137-149.
