What is the right choice? Is the answer sodium channel blockers?

Self-limited infantile epilepsy (SeLIE) is one of the most common epileptic syndromes encountered in infancy. The rapid control of seizures and determining the etiology will help the clinician and the family. Care providers need to be aware of the implications, etiology, and management. In our study, the aim is to evaluate the characteristics and response to treatment in children with SeLIE and to raise awareness about early diagnosis and treatment options.

A total of 72 infants and children diagnosed with SeLIE were retrospectively analyzed to evaluate their clinical and prognostic data.

The average age at the time of diagnosis of patients was 7.6 ± 4 months, and the onset of seizures was 7 ± 3.7 months, and 54.1% were boys in the study group. Of the patients with normal neurodevelopmental steps, 38 (52.7%) had focal elementary motor seizures, 17 (23.6%) had focal impaired consciousness seizures with observable manifestation, 16 (22.2%) had bilateral tonic-clonic seizures of unknown onset, and 1 had focal to bilateral tonic-clonic seizure initially. The most common anti-seizure medication chosen as the first-line treatment was levetiracetam in our study cohort, but the highest seizure-free rate was achieved by initiating carbamazepine.

If focal seizures occur in clusters in an afebrile infant with normal neuromotor development and normal neuroimaging, SeLIE should be considered as a possible diagnosis. Sodium channel blockers, with shown high treatment success, should be considered as the first-line medication for favorable outcomes in SeLIE.