The clinical course of untreated tonic-clonic seizures in 204 children aged 1 month to 16 years was studied at the University Hospital Rotterdam, Netherlands. Follow-up continued until start of drug treatment (78), the fourth untreated seizure (41), or for two years without treatment (85). Forty-two per cent had a decelerating pattern; they were free of seizures despite treatment being withheld. Of 41 with four or more untreated seizures, 8 had an accelerating pattern, the intervals between seizures becoming shorter. In 110 children the disease process could not be classified because treatment was started after the first, second, or third seizure. [1]

COMMENT. Previous reports of an accelerating pattern, or decreasing interval between successive untreated seizures, support the concept that seizures beget seizures (Gowers, 1881) and early introduction of antiepileptic drug treatment is recommended. The present study fails to confirm the fear that untreated tonic-clonic seizures will evolve into a progressive disorder, and favors a delay in treatment. An individualized approach is probably most appropriate, each child’s treatment based on factors predictive of seizure recurrence. For further reference to treatment onset and epilepsy prognosis, see Progress in Pediatric Neurology II, PNB Publ, 1994:pp92-93.

The risk for psychiatric and psychosomatic disorders is higher than expected in adults with childhood-onset epilepsy, regardless of continued treatment with AEDs, in a study at the University of Turku, Finland. [2]