Does the number of seizures before treatment influence ease of control or remission of childhood epilepsy? Not if the number is 10 or less

Using a population-based regional cohort of 479 children with epilepsy, we studied the effect of the number of pretreatment afebrile seizures on seizure control and remission. The number of pretreatment seizures varied from 1 to 20. For the first 10 pretreatment seizures, there was no significant difference or trend in (1) the proportion of children who were seizure free long enough to attempt stopping medication (mean, 70%), (2) the number of breakthrough seizures before control was achieved, or (3) the proportion of children who were seizure free after stopping medication for the first time (mean, 70%). More patients with more than 10 pretreatment seizures had complex partial seizures (59%) than those with 10 or fewer seizures (16%) (p < 0.00001). We conclude that there does not appear to be any penalty for seizure control or early remission of epilepsy if medication is delayed for up to 10 pretreatment seizures.