Initial treatment of epilepsy with antiepileptic drugs: pediatric issues
1David Geffen School of Medicine and Mattel Children's Hospital at University of California Los Angeles, Room 22-474 MDCC, UCLA Medical Center, Los Angeles, CA 90095-1752, USA. RSankar@ucla.edu
Insights
Choosing the right antiepileptic drug (AED) for children requires accurate diagnosis and consideration of age-specific effects. Newer AEDs offer improved tolerability and address neurobehavioral concerns in pediatric epilepsy management.
Area of Science:
- Pediatric Neurology
- Pharmacology
Background:
- Accurate syndromic diagnosis is crucial for effective initial antiepileptic drug (AED) selection in pediatric epilepsy.
- Failure to diagnose correctly often leads to treatment failure.
- Newer AEDs offer expanded choices with comparable efficacy for many pediatric seizure syndromes.
Purpose of the Study:
- To guide the selection of antiepileptic drugs (AEDs) for initial treatment in pediatric epilepsy.
- To emphasize the importance of syndromic diagnosis, efficacy, toxicity, tolerability, and neurobehavioral effects in AED selection.
- To highlight the need for AEDs specifically developed for the pediatric population.
Main Methods:
- Review of current evidence for AED efficacy and safety in childhood epilepsy syndromes.
- Assessment of age-specific organ toxicities and neurobehavioral effects of AEDs.
- Consideration of co-morbidities such as ADHD, autism, depression, anxiety, and migraine.
Main Results:
- Efficacy data (Class I or II evidence) are limited for many childhood epilepsy syndromes, necessitating reliance on the best available data.
- Relative toxicity, tolerability, and age-specific organ toxicities are critical factors in AED selection.
- AEDs can impact neurobehavioral comorbidities, body weight, insulin sensitivity, lipid profiles, and bone health, with newer agents potentially offering advantages.
Conclusions:
- Optimal AED selection in pediatric epilepsy hinges on accurate syndromic diagnosis, balanced efficacy and tolerability, and consideration of neurobehavioral and metabolic effects.
- Newer antiepileptic drugs may provide improved outcomes regarding tolerability and management of co-morbidities.
- There is an ongoing need for AEDs specifically designed for the developing brain to enhance treatment efficacy and tolerability in children with epilepsy.
Abstract:
The selection of an antiepileptic drug (AED) for initial treatment of epilepsy in infancy, childhood, and adolescence should ideally be made after a clear syndromic diagnosis of the patient's seizure disorder. A common cause of failure of the first AED is erroneous diagnosis. The availability of new-generation AEDs has expanded the choice of available agents with comparable efficacy for most syndromes. Efficacy data based on class I or II evidence are not available for many syndromes of childhood, and selection must therefore be based on the best data available. It is also important to assess the relative toxicity and tolerability of AEDs in making the selection. It is especially important to appreciate age-specific organ toxicities. Moreover, the use of AEDs in childhood requires an understanding of their neurobehavioral effects. Important neuropsychiatric co-morbidities in children with epilepsy include attention deficit/hyperactivity disorder, autistic spectrum disorders, depression and anxiety, and thought disorders. These problems can be exacerbated or ameliorated by specific AEDs. The effect of AEDs on body weight, insulin sensitivity, lipid profile, and bone health is becoming better appreciated. Newer AEDs may offer significant advantages in this regard. Co-morbid migraine in children with epilepsy may benefit from some AEDs. There remains a continuing need for the development of newer AEDs that are targeted for the developing brain to improve the efficacy and tolerability of treatment in childhood seizure disorders.
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