When to start anticonvulsant treatment in childhood epilepsy: the case for avoiding or delaying treatment.
نویسنده
چکیده
As a young doctor I held the fairly simplistic and conventional view that patients with epilepsy need to start long term treatment with anticonvulsant drugs as soon as the diagnosis is clear. I accepted that epilepsy could not be 'diagnosed after a single seizure but believed that treatment was necessary if a recurrence happened within a year. These views were first challenged for me by a middle class couple in whose six year old daughter idiopathic grand mal epilepsy had been diagnosed after she had had three short seizures over four months. After getting me to agree that anticonvulsant drugs did not always work and were not without potential side effects they asked me to spell out the benefits from preventing further seizures. My four answers seemed a little lame to them and to me that (a) a seizure without warning may cause physical injury-for example, a fall into a fire or in front of a motor vehicle-(b) there is a slight risk of status epilepticus, which if prolonged may cause brain damage, (c) seizures are socially embarrassing, and (d) there is a widely held belief that early treatment of epilepsy improves the chances of "growing out of it." For a risk-benefit analysis of early long term anticonvulsant treatment my last answer seemed the most important but the evidence was poor. Are things any clearer now? What is the evidence that early treatment of epilepsy with anticonvulsant drugs prevents some children from developing chronic intractable epilepsy?
منابع مشابه
When to start anticonvulsant treatment in childhood epilepsy: the case for early treatment.
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عنوان ژورنال:
- BMJ
دوره 297 6662 شماره
صفحات -
تاریخ انتشار 1988