Guideline: A Child's First Unprovoked Seizure Should Not be Treated as Epilepsy

ST. PAUL – A new evidence-based practice guideline developed by the American Academy of Neurology and the Child Neurology Society recommends that physicians avoid routinely treating a child''s first unprovoked seizure with antiepileptic drugs. The guideline is published in the Jan. 28 issue of Neurology, the scientific journal of the American Academy of Neurology. It used to be common practice to treat an "unprovoked" seizure (or one not caused by serious head trauma, or an infection, or other known cause) with antiepileptic drugs (AED). But researchers and child neurologists now believe that there may be risks of chronic daily treatment with AED that could be more detrimental to the child's health or development than seizure recurrence. Therefore the risks and benefits of treatment must be individualized. Approximately 25,000 to 40,000 U.S. children experience a first unprovoked seizure each year. According to a lead author of the guidelines, about 1 percent of all children will develop epilepsy, defined as two or more incidents of unprovoked seizures. Before any treatment decisions are made, it's important to determine whether the event is truly a seizure, and if it's the child's first, said Deborah Hirtz, MD, a child neurologist and program director for clinical trials at the National Institute of Neurological Disorders and Stroke in Bethesda, Maryland. "Carefully reviewing the child's medical history may rule out any unrecognized prior seizures and a neurological exam can indicate if there are any abnormalities that increase the risk for developing epilepsy," said Hirtz. Most children with a first unprovoked seizure will have few or no recurrences, according to the guidelines, and about 10 percent will have 10 or more seizures despite therapy. Guidelines are not a substitute for the experience and judgment of a physician and are developed to enhance the physician's ability to practice evidence-based medicine.

The American Academy of Neurology is the world's largest association of neurologists and neuroscience professionals, with 34,000 members. The AAN is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer's disease, stroke, migraine, multiple sclerosis, concussion, Parkinson's disease and epilepsy.

For more information about the American Academy of Neurology, visit AAN.com or find us on Facebook, Twitter, LinkedIn and YouTube.

Editor's Notes:The Child Neurology Society is a professional organization of 1,400 child neurologists that care for children with neurological and neurodevelopmental disorders (www.childneurologysociety.org).


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