The management of epilepsy in children and adults

Area of Science:

• Neurology
• Epileptology

Background:

• The International League Against Epilepsy (ILAE) has released a new classification for epileptic seizures and epilepsies.
• This update reflects significant scientific advancements in understanding epilepsies since the last classification 28 years ago.
• The new classification highlights the importance of etiology to optimize patient management.

Purpose of the Study:

• To summarize the key aspects of the new ILAE classification of epileptic seizures and epilepsies.
• To discuss current and future therapeutic strategies for epilepsy management, including pharmacological, surgical, and non-pharmacological approaches.

Main Methods:

• Review of the recently published ILAE classification.
• Discussion of established and emerging treatments for epilepsy, including antiepileptic drugs (AEDs), epilepsy surgery, ketogenic diet, and neurostimulation.
• Consideration of genetic discoveries and the development of precision therapies.

Main Results:

• Antiepileptic drugs (AEDs) provide seizure freedom for approximately two-thirds of patients, with numerous second-generation AEDs available.
• Epilepsy surgery is the most effective treatment for drug-resistant focal epilepsy.
• Non-pharmacological therapies and ongoing research offer hope for improved seizure control in difficult-to-treat cases.

Conclusions:

• The new ILAE classification provides a framework for improved epilepsy management by emphasizing etiology.
• While current treatments are effective for many, advancements in epilepsy surgery, non-pharmacological therapies, and precision medicine are crucial for addressing uncontrolled seizures.
• Future research holds promise for more targeted and effective epilepsy treatments based on molecular underpinnings.