title: Clinical course of untreated tonic-clonic seizures in childhood: prospective, hospital based study.
abstract: OBJECTIVE
  To assess decleration and acceleration in the disease process in the initial phase of epilepsy in children with new onset tonic-clonic seizures.
  
  
  METHODS
  Hospital based follow up study.
  
  
  METHODS
  Two university hospitals, a general hospital, and a children's hospital in the Netherlands.
  
  
  METHODS
  204 children aged 1 month to 16 years with idiopathic or remote symptomatic, newly diagnosed, tonic-clonic seizures, of whom 123 were enrolled at time of their first ever seizure; all children were followed until the start of drug treatment (78 children), the occurrence of the fourth untreated seizure (41 children), or the end of the follow up period of two years (85 untreated children).
  
  
  METHODS
  Analysis of disease pattern from first ever seizure. The pattern was categorised as decelerating if the child became free of seizures despite treatment being withheld. In cases with four seizures, the pattern was categorised as decelerating if successive intervals increased or as accelerating if intervals decreased. Patterns in the remaining children were classified as uncertain.
  
  
  RESULTS
  A decelerating pattern was found in 83 of 85 children who became free of seizures without treatment. Three of the 41 children with four or more untreated seizures showed a decelerating pattern and eight an accelerating pattern. In 110 children the disease process could not be classified, mostly because drug treatment was started after the first, second, or third seizure. The proportion of children with a decelerating pattern (42%, 95% confidence interval 35% to 49%) may be a minimum estimate because of the large number of patients with an uncertain disease pattern.
  
  
  CONCLUSIONS
  Though untreated epilepsy is commonly considered to be a progressive disorder with decreasing intervals between seizures, a large proportion of children with newly diagnosed, unprovoked tonic-clonic seizures have a decelerating disease process. The fear that tonic-clonic seizures commonly evolve into a progressive disease should not be used as an argument in favour of early drug treatment in children with epilepsy.
authors.affiliation: Department of Neurology, University Hospital, Rotterdam Dijkzigt, Netherlands.
authors.forename: C A
authors.initials: CA
authors.lastname: van Donselaar
authors.forename: O F
authors.initials: OF
authors.lastname: Brouwer
authors.forename: A T
authors.initials: AT
authors.lastname: Geerts
authors.forename: W F
authors.initials: WF
authors.lastname: Arts
authors.forename: H
authors.initials: H
authors.lastname: Stroink
authors.forename: A C
authors.initials: AC
authors.lastname: Peters
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D018450:Disease Progression; D004830:Epilepsy, Tonic-Clonic / Q000150:complications / Q000188:drug therapy; D006760:Hospitalization; D006801:Humans; D007223:Infant; D011446:Prospective Studies; D012008:Recurrence