[Partial seizures in childhood]

Partial seizures make up 49.3% of the epilepsies of school-age children and adolescents, and is the most prevalent type of epilepsy. Patients with complex partial seizures have more recurrences than other patients who have generalized seizures. We analyze the factors which worsen the prognosis in refractory partial epilepsies, their cost in childhood, the characteristics of the new drugs, and the few comparative studies of combinations of these drugs in resistant partial crises of childhood.

The essential factors for prediction are previous brain damage, early onset of the seizures and presence on the EEG recording of marked paroxystic anomalies. Convincing studies on the economic aspects of the epilepsies should not be limited to the cost of the disease, but be descriptive studies which measure all the costs caused by epilepsy. It has been shown that the economic impact of the disorder on children with refractory epilepsy is 2.7 times the average cost of children whose seizures are well-controlled. There are no marked differences between the new antiepileptic drugs in the treatment of seizures of this type. Their appearance has led to reconsideration of what is rational bitherapy and what benefit may be obtained with it.

When possible associations of antiepileptic drugs are considered, one should take into account criteria of efficacy and toxicity, the pharmacodynamic characteristics of the drugs to be used together and their pharmacokinetic interactions. It is necessary to avoid drugs with a low therapeutic index to which tolerance may develop or which interact frequently, and antiepileptic drugs with a broad spectrum, high therapeutic index and few pharmacokinetic interactions should be preferred. The association of valproate and viagabatrin may be very beneficial, since it has been suggested that there is a synergistic reaction in patients with partial seizures that are resistant to other drugs. The efficacy of the association of valproate and viagabatrin has been shown in patients with refractory partial seizures, since they have different modes of action and different spectrums, different profiles of toxicity and no pharmacokinetic interactions. Finally, we describe the basic principles of treatment of refractory partial seizures of childhood.