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Treatment of children with "ordinary" epilepsy
1Department of Pediatrics, Dalhousie University, Nova Scotia, Canada.
Insights
Many children with epilepsy experience seizure remission without medication. Treatment decisions for pediatric epilepsy should be individualized, as routine monitoring offers no proven benefit for asymptomatic children.
Area of Science:
- Pediatric Neurology
- Epileptology
Background:
- Epilepsy in children often has a benign course with eventual remission.
- Identifying children who will remit is challenging at diagnosis.
- Treatment decisions are often influenced by fears rather than absolute indications.
Purpose of the Study:
- To evaluate the necessity and approach to treating childhood epilepsy.
- To inform clinical decision-making regarding antiepileptic drug (AED) initiation and cessation.
- To assess the utility of routine monitoring in pediatric epilepsy management.
Main Methods:
- Review of clinical course and treatment outcomes in children with epilepsy.
- Analysis of factors influencing treatment decisions.
- Evaluation of evidence for routine laboratory screening and serum drug level monitoring.
Main Results:
- Not all children with epilepsy require treatment; many achieve remission.
- Routine blood and urine screening for asymptomatic children offers no proven benefit.
- Serum drug level monitoring has limited clear benefit.
- Stopping medication after 6-12 months of seizure freedom is reasonable, with rare loss of seizure control upon recurrence.
Conclusions:
- Individualized assessment is crucial for treatment decisions in pediatric epilepsy.
- Routine toxicity screening and serum drug level monitoring are not beneficial for asymptomatic children.
- A significant proportion of children with epilepsy can achieve remission and discontinue AEDs successfully.
Abstract:
Many children with epilepsy have a relatively benign clinical course with eventual remission of their seizures and no further need for medication. It is not easy to be sure who these children are at the time of diagnosis, but they do not have catastrophic epilepsy. Epilepsy is best defined as two unprovoked seizures. Not all of these children require treatment and treatment is motivated by fear of brain damage, injury, death, kindling of additional seizures, and social consequences. None of these fears provides an absolute indication for treatment. The decision to start medication should be considered on an individual basis. The choice of a first AED is arbitrary with most AEDs having equal efficacy. Follow-up schedules have not been well studied. However, there is fairly convincing evidence that routine blood and urine screening for toxicity is of no benefit, if the child is asymptomatic. Serum drug levels are of little clear benefit. Once the child has been seizure-free for 6 months to 12 months, it is reasonable to consider stopping medication. Only rarely does seizure control fail to return if there are recurrences without medication.
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