Drug treatment of paediatric epilepsy

The decision to treat a child with a drug depends upon the individual (frequency of seizures, epilepsy syndrome and neurological findings) and also the wishes of the parents/carers. It remains unclear when drug treatment should beginl-3, and numerous attempts have been made to accurately predict the risk of epilepsy developing (i.e. recurrent, spontaneous seizures) after the first unprovoked seizure3. Nevertheless, the decision to treat  and when to treat  remains an individual one. Most clinicians would not recommend starting treatment after a single, brief generalised tonic-clonic seizure, but would after a cluster of seizures or, possibly, after an episode of unprovoked status epilepticus. Similarly a child with severe physical and learning difficulties who develops infrequent myoclonic or generalised atypical absence or focal seizures may not necessarily require an AED. The recently published ILAE working definition of epilepsy takes these considerations into account4.