PEDIATRICS Vol. 53 No. 4 April 1974, pp. 529-530
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INTRODUCTION: The Treatment of Paroxysmal Disorders

John H. Menkes M.D.1

1 Departments of Pediatrics, Neurology and Psychiatry, UCLA School of Medicine, The Center for the Health Sciences, Los Angeles, and the Brentwood V.A. Hospital

As the accompanying series of papers indicates, the treatment of paroxysmal disorders in childhood is still an art, laid down on a thin groundwork of scientific information.

While there is unanimous agreement that all patients with recurrent seizures should be treated as soon as the diagnosis is established, there is considerable controversy regarding the optimum method of dealing with certain patients.

1. Febrile convulsions. There is considerable controversy as to whether a child who has experienced his first febrile convulsion should receive continuous prophylactic anticonvulsant therapy. Controlled prospective studies have indicated that the mcidence of recurrent febrile convulsions is not significantly less in patients who have been placed on daily doses of phenobarbital or diphenylhydantoin than those on intermittent anticonvulsants administered only at the time of a febrile episode, or on no therapy at all. It is possible that the failure of phenobarbital prophylaxis is due to inadequate blood levels, and serum barbiturate levels of 1.5 mg/100 ml or higher may be required to prevent further febrile convulsions.

2. The child with an isolated major motor convulsion. I believe that treatment of this type of patient is optional, and to a large measure dependent on social factors. While phenobarbital, the drug of choice in this instance, has few side effects, it must be stressed that sudden withdrawal of the drug by the parents, unconvinced of its necessity, may precipitate status epilepticus.

3. Breath-holding spells. Most authorities agree that antiepileptic drugs are of no value in preventing recurrence of attacks.