Treatment of a single seizure or recurrent seizures is also different that treatment of a seizure that just won't stop (status epilepticus), which is a medical emergency.
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Having a single seizure is usually not an indication for beginning treatment, since there is a 60-70% chance that your child will not have another seizure.
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Treatment for idiopathic seizures is usually considered for children who have had two or more seizures. Having a single seizure is usually not an indication for beginning treatment, since there is a 60-70% chance that your child will not have another seizure. What are the consequences of not starting treatment? Usually just that your child will have another seizure. Single seizures do not cause brain damage, so it is usually safe to wait and see if your child is going to have more seizures before starting treatment.
A lot of factors go into the decision on whether or not to start medications, so you should discuss it carefully with your Pediatrician or Pediatric Neurologist. In general, the risk of the medication vs the risk of your child having another seizure needs to be considered.
Once it is decided that your child should be started on treatment, the choice of medication depends on your child's type of seizures. While there is no cure for seizures, antiseizure medications can usually completely control seizures in about 70% of children. Another 10-15% of children will have good control of their seizures with medications.
Children with generalized tonic-clonic seizures are usually first treated with either phenobarbital, phenytoin (dilantin), carbamazepine (tegretol), or sodium valproate (depakene or depakote). Absence seizures are usually best treated with either sodium valproate (depakene or depakote) or ethosuximide (zarontin).
Partial seizures are usually first treated with either carbamazepine (tegretol), phenytoin (dilantin), or sodium valproate (depakene or depakote).
While many children have their seizures managed with a single medicine (monotherapy), some require more than one medication (polytherapy) for effective control. If seizures are poorly controlled, the dosage of a single medication is usually increased until either the seizures are controlled or the child is having too many side effects. At that point, either the medicine will be changed or an additional medicine will be started.
Newer medications that can be used to treat seizures include lamotrigine (lamictal), and gabapentin (neurontin).
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Medications are usually continued until a child is seizure free for two years and has a normal or improved EEG
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Once a medication is started, monitoring usually involves determining how well the seizures are controlled, and periodically checking blood levels and observing for side effects, which may involve checking liver function tests (LFTs) and a complete blood count (CBC). Medications are usually continued until a child has been seizure free for at least two years and has a normal or improved EEG, after which children have a 75-95% chance of not having any more seizures when the medications are stopped.
Other treatments for refractive seizures that are difficult to control can include using a ketogenic diet and sometimes surgery.
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