Evidence base (EB) aproach to the first unprovoked epileptic seizure

Epileptic seizure is symptom of acute diseases (provoked seizure with known cause) or epilepsy (unprovoked epileptic seizure with no irritated factor). For establishment of seizure type a precise anamnesis is necessary and an EEG (video-polygraphy when awake, during sleep, after deprivation, with photostimulation, hyperventilation). Normal EEG, as well as an abnormal EEG with a positive family history of epilepsy does not confirm epileptic seizure. With clinical evaluation of the first unprovoked or repeated epileptic seizure, the exact classification of seizure, epilepsy or syndrome will be established. A non-provoked epileptic seizure will be repeated in 14-65% children in one year. In children with idiopathic/cryptogenic seizures the risk for repetition is 30-50% and in children with symptomatic cause the risk is higher than 50% in a 2 year period from the unprovoked seizure. About 46% of children followed-up over 10yrs had one or more epileptic seizures after the first unprovoked seizure. According to the literature data, even prolonged seizures rarely cause brain damage in children, except in connection with acute neurological disturbances. One of the reasons for starting antiepileptic therapy (AET) is the fear of injury or death during the next seizure. To lessen the cause of injury, it is necessary to reduce all possible risks during the daytime. Sudden death in children with epilepsy is a rarity and is connected to some kind of neurological damage. There is no study with a description of a lesser risk of injury or sudden death in children with AET introduced after the first unprovoked seizure. According to two studies of class II and four studies of class III according to EB criteria, there is no difference in terms of the chance of repeated seizure in children with AET and those without AET. The decision about introducing AET or not, in children or adolescents after the first unprovoked epileptic seizure should be based on the possibility of repeated epileptic seizures and the danger of permanent AET that can influence the child’s cognitive development, behaviour, physical and psychosocial development. The decision should be evaluated individually for each child taking into account the medical reasons together with the decisions of the patients and family. Recommendations after the first unprovoked epileptic seizure: AET is not indicated for prevention of development of epilepsy (level B); 2. Treatment with AET should be considered as a possibility of preventing the next seizure and the risk of pharmacological and psychosocial side-effects (level B). At first, in a child with the first epileptic seizure, all gathered data, clinical features and findings should be considered together with a detailed clinical evaluation, instead of immediate initiation of AET treatment.
Category: Abstracts
Volume: Vol. 52, No 3, july - september 2008
Authors: Lj. Cvitanović-Šojat
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