A Clinical Approach to the Child with Seizures and Epilepsy

Summary: Generalized tonic‐clonic seizures in children may have different causes and a different natural history than seizures and epilepsy in adults. The effects of medication may also be of greater importance during childhood. In making decisions about whether or not to treat a child who has had only one or a few seizures, the physician must consider the chance of further seizures and the possible consequences of further seizures. Since the major consequence of seizure recurrence is psychosocial, and since the psychosocial consequences of infrequent seizure recurrence vary with age during childhood and differ from those in adults, decisions about therapy should take these differences into account. The potential effects of anticonvulsants on learning and behavior should also be considered. Seizures should not be treated just “because they are there,” but rather only when the risks and consequences outweigh the benefits of being free of medication and its effects. In summary, why do we treat seizures? We treat seizures because of their consequences. However, when talking about the patient who has had a single seizure or even two seizures, the consequences vary with age, with the time of the seizure, and with the precipitating factors of the seizure. Clearly, these are not the same for all individuals. In view of the side effects of medications and their lack of complete efficacy, perhaps we need not treat every patient who has had one or two seizures. The decision to treat, or not to treat, should be made in conjunction with the patient and/or the family, carefully weighing the unknowns on both sides of this equation. If this is done, then, not everyone who has one seizure or even two seizures will, or should, be treated.