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Antiepileptic Drugs in Children with Developmental Delays and Behavioral Problems
1Division of Child Neurology, Departments of Neurology, Pediatrics, and Pharmacy and Pharmaceutics, Medical College of Virginia, Richmond, VA 23298, USA. jmpellock@hsc.vcu.edu
Insights
Treating epilepsy in children with developmental delays requires individualized strategies. The best antiepileptic drug (AED) depends on seizure type, syndrome, and potential side effects, with newer options offering advantages.
Area of Science:
- Pediatric Neurology
- Epileptology
- Child Psychiatry
Background:
- Children with multiple handicaps often experience epilepsy, necessitating treatment.
- Epilepsy management in this population requires distinct acute and chronic treatment strategies.
Purpose of the Study:
- To review current approaches to epilepsy treatment in children with multiple handicaps.
- To highlight factors influencing the selection of antiepileptic drugs (AEDs) for this specific patient group.
Main Methods:
- Review of existing literature and clinical experience regarding AEDs in children with developmental delays and behavioral problems.
- Analysis of treatment strategies for acute versus chronic epilepsy management.
- Evaluation of common AEDs, including phenobarbital, carbamazepine, and valproate, and newer alternatives.
Main Results:
- No single AED is universally effective; treatment must be individualized.
- Phenobarbital is less favored due to behavioral side effects.
- Carbamazepine is preferred for partial seizures, while valproate is a broad-spectrum option for generalized seizures.
Conclusions:
- Individualized AED selection is crucial, considering seizure type, epilepsy syndrome, efficacy, and side effect profiles.
- Newer AEDs offer valuable alternatives for children experiencing adverse effects from traditional medications, potentially providing cognitive and behavioral benefits.
Abstract:
Children with multiple handicaps, including developmental delays and behavioral problems, frequently have epilepsy that requires treatment. Different strategies should be used for acute treatment versus chronic treatment. Experience suggests that there is no true drug of choice that can be used for all children with epilepsy; however, seizure type, epilepsy syndrome, and likely efficacy and side effect spectrum of the antiepileptic drug (AED) will determine the best treatment for each child. In general, phenobarbital has posed multiple behavioral problems, and, thus, is less commonly used. Carbamazepine is the most frequently used drug for the treatment of partial seizures with or without secondary generalization, and valproate is the long established, broad spectrum AED for children with generalized convulsive and nonconvulsive seizures. Newer AEDs allow alternative treatments to those with adverse effects to the more frequently used medications and may have cognitive or behavioral advantages.