What is the role of acute anticonvulsant therapy in the treatment of pediatric first seizure?

Updated: Aug 16, 2018
  • Author: Shelley R Waite, MD; Chief Editor: Amy Kao, MD  more...
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The decision of whether or not to initiate anticonvulsant treatment after a first seizure must be based on the clinical scenario and risks and benefits determined for the individual patient. In general, anticonvulsant drugs are used to decrease the probability of recurrent seizures; however, they have not been found to prevent the development of epilepsy after first seizure. [4, 11]

In patients presenting in status epilepticus or in acutely ill children (eg, seizures associated with encephalitis), in which the chance of a recurrent seizure is high, medications that can be administered quickly through intravenous access (IV) access, such as benzodiazepines, fosphenytoin, phenobarbital, valproic acid, or levetiracetam are useful. A prescription for rectal diazepam (Diastat) for use at home if patients have a recurrent prolonged seizure in the future may be useful.

In some situations, such as simple febrile seizures, the risks and potential side effects of chronic anticonvulsant therapy may outweigh the benefits, and treatment is not typically offered.

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