Practice parameter: Treatment of the child with a first unprovoked seizure

Abstract

Abstract-The Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society develop practice parameters as strategies for patient management based on analysis of evidence regarding risks and benefits. This parameter reviews published literature relevant to the decision to begin treatment after a child or adolescent experiences a first unprovoked seizure and presents evidence-based practice recommendations. Reasons why treatment may be considered are discussed. Evidence is reviewed concerning risk of recurrence as well as effect of treatment on prevention of recurrence and development of chronic epilepsy. Studies of side effects of anticonvulsants commonly used to treat seizures in children are also reviewed. Relevant articles are classified according to the Quality Standards Subcommittee classification scheme. Treatment after a first unprovoked seizure appears to decrease the risk of a second seizure, but there are few data from studies involving only children. There appears to be no benefit of treatment with regard to the prognosis for long-term seizure remission. Antiepileptic drugs (AED) carry risks of side effects that are particularly important in children. The decision as to whether or not to treat children and adolescents who have experienced a first unprovoked seizure must be based on a risk-benefit assessment that weighs the risk of having another seizure against the risk of chronic AED therapy. The decision should be individualized and take into account both medical issues and patient and family preference. NEUROLOGY 2003;60:166 -175 Population-based studies of the incidence of first unprovoked seizures suggest that there are between 25,000 and 40,000 children per year in the United States who experience a first unprovoked seizure. [1][2][3][4] Until relatively recently, it was common practice for physicians to begin long-term, daily antiepileptic drug (AED) therapy after a child or adolescent experienced a single seizure of any type. The rationale for this practice was based on the belief that all seizures were likely to recur and that seizures could be dangerous and cause brain damage. Furthermore, it was thought that if any recurrence were to take place, this would lead to progressively more seizures. It was also assumed that AED were safe, had few side effects, and were effective in prevention of seizure recurrences. These assumptions have undergone substantial modification over the last 20 years, leading to a more optimistic view about the nature of seizures and a more conservative approach to the use of treatment. However, no clear evidence-based guidelines have emerged regarding the initiation of treatment after a first unprovoked seizure in the pediatric population.Practice parameters are developed by the Quality

Quality improvement in neurology: AAN epilepsy quality measures

“…The literature search identified 160 relevant recommendation statements from 19 guidelines [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] and 2 consensus papers. [32][33] Review by the co-chairs and facilitator resulted in 20 recommendation statements that were rated highest on importance, validity, strength of evidence, and gaps in care to serve as the evidence base for 12 candidate measures.…”

Injury Among Children and Young Adults With Epilepsy

“…51 For fractures and thermal injuries, the increase in absolute risk associated with epilepsy is small. Given the greater risk of poisoning, particularly among young adults, efforts should be made to prevent this injury.…”

Injury Among Children and Young Adults With Epilepsy

“…All healthcare professionals can use these findings to inform parents, children and young adults diagnosed with epilepsy of their absolute risk of injuries as part of counselling for unintentional injury prevention 51 and to inform existing guidelines on treatment 52 . For fractures and thermal injuries, the increase in absolute risk associated with epilepsy is small.…”