Related Experiment Videos
Clinical course of untreated tonic-clonic seizures in childhood: prospective, hospital based study
C A van Donselaar1, O F Brouwer, A T Geerts
1Department of Neurology, University Hospital, Rotterdam Dijkzigt, Netherlands.
Insights
Many children with new onset tonic-clonic seizures show a decelerating disease pattern, often improving without medication. This suggests early drug treatment may not always be necessary for childhood epilepsy.
Area of Science:
- Pediatric Neurology
- Epileptology
Background:
- Epilepsy is often perceived as a progressive neurological disorder.
- The initial phase of new onset tonic-clonic seizures in children requires careful characterization of disease progression.
Purpose of the Study:
- To evaluate the disease trajectory in children experiencing their first tonic-clonic seizures.
- To differentiate between decelerating, accelerating, and uncertain disease patterns in the early stages of childhood epilepsy.
Main Methods:
- A hospital-based follow-up study was conducted in the Netherlands.
- 204 children (1 month to 16 years) with newly diagnosed tonic-clonic seizures were analyzed.
- Disease patterns were categorized based on seizure frequency and intervals between seizures, with follow-up until treatment initiation, the fourth seizure, or two years.
Main Results:
- A decelerating disease pattern was observed in 83 out of 85 children who became seizure-free without treatment.
- Among children with four or more untreated seizures, 3 showed a decelerating pattern and 8 an accelerating pattern.
- The disease pattern was uncertain in 110 children, primarily due to early initiation of drug treatment.
Conclusions:
- A significant proportion of children with newly diagnosed, unprovoked tonic-clonic seizures exhibit a decelerating disease process.
- The findings challenge the notion that untreated epilepsy invariably progresses with decreasing seizure intervals.
- Early drug treatment should not be solely based on the fear of disease progression in pediatric epilepsy.
Objective:
To assess decleration and acceleration in the disease process in the initial phase of epilepsy in children with new onset tonic-clonic seizures.
Study Design:
Hospital based follow up study.
Setting:
Two university hospitals, a general hospital, and a children's hospital in the Netherlands.
Patients:
204 children aged 1 month to 16 years with idiopathic or remote symptomatic, newly diagnosed, tonic-clonic seizures, of whom 123 were enrolled at time of their first ever seizure; all children were followed until the start of drug treatment (78 children), the occurrence of the fourth untreated seizure (41 children), or the end of the follow up period of two years (85 untreated children).
Main Outcome Measures:
Analysis of disease pattern from first ever seizure. The pattern was categorised as decelerating if the child became free of seizures despite treatment being withheld. In cases with four seizures, the pattern was categorised as decelerating if successive intervals increased or as accelerating if intervals decreased. Patterns in the remaining children were classified as uncertain.
Results:
A decelerating pattern was found in 83 of 85 children who became free of seizures without treatment. Three of the 41 children with four or more untreated seizures showed a decelerating pattern and eight an accelerating pattern. In 110 children the disease process could not be classified, mostly because drug treatment was started after the first, second, or third seizure. The proportion of children with a decelerating pattern (42%, 95% confidence interval 35% to 49%) may be a minimum estimate because of the large number of patients with an uncertain disease pattern.
Conclusions:
Though untreated epilepsy is commonly considered to be a progressive disorder with decreasing intervals between seizures, a large proportion of children with newly diagnosed, unprovoked tonic-clonic seizures have a decelerating disease process. The fear that tonic-clonic seizures commonly evolve into a progressive disease should not be used as an argument in favour of early drug treatment in children with epilepsy.