Unprovoked seizures in childhood

Abstract

Convulsions are frequent in children, and they constitute great alarm into the family. An analysis of the recurrence risk after a first unprovoked seizure, and the evidences of the convenience not indicating preventive treatment for future seizures is made. It is important to make a global and rational evaluation of the clinical condition in cost/benefit terms, considering the tests to be asked, and the eventual treatment, in order to assure the greater benefit to the child and his family. At present, it is considered that a first unprovoked seizure although it always requires an investigation, usually it does not mean a significative threaten for the future of the child. An aspect to emphasize is the need to make a careful differential diagnosis between convulsions and other paroxistical phenomenons of frequent presentation in children. Until not long time ago, it was estimated that the possibility of recurrence of a first seizure was very high, and moreover that seizures frequently produced brain damage, reason why many of these children were submitted to long treatments with antiepileptic drugs. Recent publications demonstrate that seizures, depending on their characteristics, generally do not produce clear brain damage, and instead, antiepileptic drugs, frequently show significant secondary effects at cognitive, behavioral and systemic level. The decisions must take into account the etiology and circumstances of the first seizure, the consequences of an eventual new seizure, so much from the physical as well as from the psychosocial viewpoint, and the secondary effects of antiepileptic drugs. For this reason, at present, the most prevalent opinion is to investigate the etiology and not indicate antiepileptic treatment to the child who has presented a first convulsion, in the majority of the cases.