Treatment options in pediatric epilepsy syndromes

Recent evidence suggests that various epilepsy syndromes respond differently to antiepileptic drugs. It follows that a more precise diagnosis, together with a better understanding of AED mechanisms of action, enables them to be used more specifically, and therefore more effectively. Patient characteristics including age of onset, seizure frequency, EEG data and the findings of imaging studies, provide diagnostic pointers which enable the physician to reach a syndrome diagnosis and to choose the most appropriate AED for the individual patient. Home videotapes of paroxysmal events are becoming increasingly available and are often of great assistance. Parents should be encouraged to record their children's attacks. Careful history-taking and correct interpretation of clinical data remain the cornerstones of accurate diagnosis and successful treatment. However, the specificity of antiepileptic drugs is relatively limited and often pharmacotherapy should start using an agent with a broad spectrum of activity appropriate for the primary seizure type. It is in fact common that several antiepileptic agents have similar or identical effectiveness for one particular form of epilepsy. Therefore, the eventual side effects and the greater or lesser difficulties in handling the drug play an essential role in the choice of a therapeutic agent. Polypharmacy should be avoided and surgery should be considered early for selected patients, particularly children, who fail to respond to an appropriate drug trial. Correct diagnosis and the first drug(s) used may have a crucial impact on the evolution of given epilepsy. One major emphasis in the management of epilepsy is on information that should be complete, adapted to the level of understanding, and objective, although given in a positive manner. The understanding and cooperation of children and their families is clearly decisive for the success of therapy, and this requires a confident relationship between the physician and the patient. Current knowledge, on antiepileptic drugs options in paediatric epilepsy syndromes, is discussed.