What is the role of chronic 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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Answer

Answer

The decision of whether to treat with long-term anticonvulsant therapy after a first unprovoked seizure requires consideration of the risks of medication adverse effects and psychological stigma against the risk of recurrent seizure. Decisions must be made on an individualized basis and should involve discussions with the patient and family.

As a care guideline, most pediatric neurologists would not start chronic anticonvulsants after a first-time seizure, unless prominent risk factors for epilepsy (eg, cerebral palsy, mental retardation, brain structural lesions, abnormal EEG) are known to exist. [11, 12] Even if increased recurrence risk is determined, many neurologists would delay starting chronic anticonvulsants until a second unprovoked seizure occurred, establishing adequate frequency of seizures to warrant medication.

This general practice is guided by data from both adult and pediatric studies, which show that delayed treatment of seizure disorders does not reduce the likelihood of seizure freedom and may spare some individuals from long-term antiepileptic drug treatment. [1, 13]

If anticonvulsant medications are initiated, the choice of medication should be made based on seizure type. Some medications have been shown to be highly efficacious for some types of seizures but worsen other types. For example, carbamazepine can be helpful against partial seizures but can exacerbate generalized absence seizures.

In most childhood epilepsies, anticonvulsant prophylaxis is maintained until the child is seizure-free for 1-2 years or until an appropriate age when the child would no longer be expected to be at risk of having seizures.

Patients at risk of seizures or lapses of consciousness who are old enough to drive must be carefully evaluated and reported to state authorities per mandates of individual state laws. Find out more information at the Epilepsy Foundation.


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