Controversies in Management: Do anticonvulsants alter the natural course of epilepsy? Treatment should be started as early as possible

Throughout this century the pharmacological treatment of epilepsy has been based on the Jacksonian concept, reinforced after Berger's discovery of the electroencephalograph, that seizures represent neuronal discharges that need to be suppressed by antiepileptic drugs. According to this view, when antiepileptic drugs are withdrawn seizures may be expected to recur unless the seizure disorder has gone into spontaneous remission, which apparently happens in a high percentage or cases.1

A more recent view, which has some neglected historical roots,2 suggests that antiepileptic drugs may also influence the natural history of epilepsy, that epilepsy should be viewed as a process that has the potential to develop into an intractable disorder, and that early effective treatment may reduce this risk of chronicity.3 4