The effect of the number of seizures before antiepileptic drug (AED) treatment on the ease of seizure control and remission was studied in a population-based regional cohort of 479 children with epilepsy at the IWK Children’s Hospital, Halifax, Nova Scotia, Canada. Only 55 of 99 patients (56%) with more than 10 pretreatment seizures were seizure free for a sufficient time to attempt discontinuation of medicine, compared with 276 of 380 patients (73%) with 10 or fewer seizures. When patients discontinued AED treatment, 232 of 331 patients overall (70%) remained seizure free. For each pretreatment seizure number greater than one, the number of patients successfully discontinuing medication was the same. Of those treated after a single seizure, 57% were seizure free after AED discontinuation, compared to 72% with more than one pretreatment seizure. Patients with more than 10 pretreatment seizures were more likely to have complex partial seizures (59%) than those with 10 or fewer seizures (16%). 
COMMENT. These findings tend to disprove the theory that seizures beget seizures, at least in children permitted to have 10 or fewer seizures before treatment with AEDs is begun. The ease of seizure control and frequency of remission are unaltered if medication is delayed for up to 9 recurrences. Children excluded from this study were those with myoclonus, absence, akinetic, and infantile myoclonic seizures, which are too numerous to count. The introduction of antiepileptic treatment after a first or second seizure in children with generalized tonic-clonic or partial seizures requires further evaluation. Each patient must be considered as an individual, and these findings should be weighed in conjunction with past practices when considering advisability of antiepileptic treatment. Some previous studies have found that risk factors for seizure relapse after withdrawal of antiepileptic treatment have included delay in initiation of therapy. See Progress in Pediatric Neurology I, PNB Publishers, 1991, pp 100-104.