Children who suffer their first ever epilepsy seizure are no worse off for having any treatment delayed to see if a second seizure occurs, researchers have discovered.
A treatment delay does not reduce the chances of controlling the seizures later nor does it affect possible remission when the child grows.
The only advantage of starting immediate treatment is that it can delay the next seizure, but doctors and parents who insist on it after the very first attack will never know if it was going to be the only one.
The researchers followed the progress of 479 children who had their first seizure aged one month to 16 years, and who had two or more seizures.
Those who had treatment immediately after the first seizure suffered a second one nearly 15 months later, while those who had treatment delayed had their second seizure after just 4.4 months (Neurology, 1996; 46:41-4).
Nine per cent of children given phenobarbitone to treat their epilepsy had to come off it because of the serious side effects they suffered, researchers discovered.
In one of the first ever medical trials to assess the safety of anti epilepsy drugs on children virtually all previous trials had been with adults researchers found a similar problem with phenytoin. Reactions were at 4 per cent among children given one of two of the other drugs tested, sodium valproate and carbamazepine.
The research, among 167 children aged between three and 16, was carried out by King's College Hospital in London. Researchers had problems recruiting enough children because many doctors were opposed to them being given phenobarbitone, still the only treatment for epilepsy in many countries, while others were worried about sodium valproate.