Epilepsy: a progressive disease?

BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7078.391 (Published 08 February 1997) Cite this as: BMJ 1997;314:391

Still no answer to the controversy over whether seizures beget more seizures

  1. Bernard Sadzot, Associate professora
  1. a Department of Neurology, Centre Hospitalier Universitaire, B-4000 Liege, Belgium

    It is amazing how after years of scientific research and therapeutic progress many simple and basic questions about the epilepsies remain unanswered. Even the natural course of epilepsy is not well known because of the widespread use of antiepileptic drugs. Gowers suspected that seizures trigger subsequent seizures or, in other words, that there is a facilitation phenomenon.1 This idea still survives but has yet to be substantiated. We also do not know if antiepileptic drugs alter the natural course of epilepsy and prevent chronicity and intractability developing. Are the risks of further seizures in newly diagnosed patients (especially children) worth the side effects associated with antiepileptic drugs? What is the optimum time to begin treatment? Clinical studies have produced diverging and sometimes conflicting views on these problems.

    In this week's BMJ, van Donselaar et al (p 401) followed 204 untreated children aged 1 month to 16 years who experienced one (123 patients) or more idiopathic or “remote symptomatic” tonic-clonic seizures (including seizures with partial onset).2 They analysed the time between seizures until the start of treatment, the fourth untreated seizure, or the end …

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