Treatment of seizures in childhood

Epilepsy is a common disorder of childhood occurring with an incidence in the range 46–60 out of 100,000 in the Western world. It is most common in the fi rst year of life, and declines progressively after the age of 10 years. Based on clinical and electrophysiologic fi ndings, two main forms of epilepsy are recognized: localization-related (partial) and generalized. The question of ‘when to treat’ has been addressed fairly extensively, and the general consensus of opinion is that seizure treatment can be deferred after a single unprovoked seizure, as antiepileptic drugs (AEDs) do not eliminate recurrence and do not have an effect on longterm remission [1]. Meta-analyses suggest that the chance of recurrence after a single generalized seizure is 30–50%, and after a second event is 70–80% [2–4]. The def inition of epileptic seizure has been suggested as ‘transient occurrence of signs/symptoms owing to abnormal excessive or synchronous neuronal activity in the brain’. The International League Against Epilepsy (ILAE) has proposed that epilepsy be defi ned as ‘disorder of the brain characterized by an enduring predisposition to generate epileptic seizure and by the neurobiological, cognitive, psychological and social consequences of this condition.’