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Guidance Change for First Seizure in Kids

New Guidelines Call For "Wait-And-See" Approach Regarding Drugs
WebMD Health News

Jan. 27, 2003 -- New guidelines recommend that doctors not immediately turn to anti-epileptic drugs following a child's first seizure. The guidelines apply to seizures that are "unprovoked" by trauma such as a head injury or some other known cause.

The guidelines from the American Academy of Neurology and the Child Neurology Society reverse the current standard practice, in which doctors generally medicate a child despite the fact that only one-third to one-half will have another seizure, according to Deborah Hirtz, MD, pediatric neurologist at the National Institute of Neurological Disorders and Stroke. She is one of the authors of the guidelines, which will be published in the January 28 issue of the journal Neurology.

As many as 40,000 children in the U.S. experience a first-time seizure in any given year; 1% of all children develop epilepsy, defined as two or more unprovoked seizures. Treatment with anti-epileptic drugs immediately after the first seizure was based on the belief that seizures were likely to happen again and would cause long-term brain damage. It was also believed that theses drugs were safe and had few side effects.

The new guidelines are based on a review of studies about the risks of future seizures, the effect of drug therapy to prevent future seizures, and the risks of developing chronic epilepsy.

Although drugs are effective at preventing further seizures in adults, only a few studies have actually looked at whether drugs prevent future seizures in children. Antiepileptic drugs have a high frequency of side effects, ranging from declines in intelligence scores to hyperactivity and sedation, depending on the drug. Many of the side effects are subtle. "Unless teachers and parents and the treating physician are asking questions and looking for them, there may be some adverse effects that are long-term and not so obvious," Hirtz tells WebMD.

Those problems led to a re-examination of the standard practice. Seizures are only inherently dangerous if they go on for a prolonged period of time, such as a half an hour, according to Hirtz. They are more commonly a source of danger when they strike at an inopportune time, such as while swimming or riding a bike. For that reason, Hirtz recommends that parents make sure children who have experienced a seizure don't do such activities alone. "These are really just exaggerations of the normal care of a kid," she says.

In addressing the risk of a second seizure and the potential risks associated with it, the report says even prolonged seizures rarely cause significant brain damage unless there is an associated condition like a brain bleed.

As far as the risks of a second seizure, the report says studies have shown the majority of recurrences happened within the first one to two years. A year after a first seizure, the risk can range from 14%-65%.

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