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What are the considerations when initiating treatment for epilepsy in children?
Francesco Pisani1, Carlotta Spagnoli2
1Human Neurosciences Department, Sapienza University of Rome, Rome, Italy.
Insights
Choosing the right epilepsy medication for children requires careful consideration of many factors. Precision medicine offers a promising approach for treating genetic epilepsies and improving neurodevelopmental outcomes.
Area of Science:
- Pediatric Neurology
- Pharmacology
- Genetics
Background:
- Epilepsies and developmental and epileptic encephalopathies in children present a wide spectrum, ranging from mild to severe drug-resistant forms.
- Selecting appropriate antiseizure medications is critical for managing these conditions.
Purpose of the Study:
- To review key factors influencing antiseizure medication prescription in pediatric patients.
- To highlight the role of precision medicine and pharmacogenomics in treating childhood epilepsies.
Main Methods:
- Literature search conducted via PubMed for antiseizure medications in patients aged 0-18.
- Focused on factors including age, seizure type, epilepsy syndrome, etiology, efficacy, safety, comorbidities, gender, formulations, cost, and regulatory issues.
- Reference lists of relevant papers were also reviewed.
Main Results:
- The study emphasizes a comprehensive approach to drug selection, integrating clinical research and patient-specific factors.
- Precision medicine is identified as a rapidly advancing field for holistic treatment of genetic epilepsies.
- Pharmacogenomics is crucial for addressing adverse events and drug resistance.
Conclusions:
- Optimal drug selection in pediatric epilepsy requires a multifaceted evaluation.
- Precision medicine and pharmacogenomics hold significant potential for personalized treatment strategies and improved neurodevelopmental outcomes in children with epilepsy.
Introduction:
There is a very wide spectrum of epilepsies and developmental and epileptic encephalopathies that affect children, from self-limited forms, not necessarily requiring treatment, to severe drug-resistant ones.
Areas Covered:
In this perspective, the authors discuss the main factors to consider before drug prescription in children, considering the most recent clinical research, including age, seizure type, epilepsy syndrome, etiology, efficacy and safety profile, comorbidities, gender, available formulations, costs and drug coverage, and regulatory issues. The literature search was conducted through a PubMed search on antiseizure medications for patients aged 0-18, with respect to each of the aforementioned factors, and by checking the reference lists of relevant papers.
Expert Opinion:
The most expanding field of research and innovation for clinical practice is precision medicine, which addresses the holistic treatment of genetic epilepsies and developmental and epileptic encephalopathies. It achieves this by addressing their detrimental effects on synapses, neurotransmission, and cellular signaling pathways with the double aim to treat seizures and to rescue neurodevelopmental trajectories, but also the issue of adverse events and drug resistance through pharmacogenomics.
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