Recent Advances in the Management of Seizures in Children

Childhood epilepsies comprise a group of heterogeneous conditions associated with diverse aetiologies, seizure severities/types, comorbidities, degrees of impairment and prognoses. Seizures are refractory to antiseizure medications (ASMs) in around one-third of cases. Alternatives to medication, for example surgical resection, are not always feasible, implying that new treatments are needed. In the past decade, new ASMs have been approved for specific childhood-onset epilepsy syndromes, notably cannabidiol for Lennox-Gastaut syndrome (LGS), Dravet syndrome (DS) and tuberous sclerosis complex (TSC); fenfluramine for LGS and DS; everolimus for TSC; and ganaxolone for cyclin-dependent kinase-like deficiency disorder. However, seizure freedom with these medications has rarely been achieved in randomised controlled trials. Alongside ASM development, and surgical strategies such as laser interstitial therapy, neurostimulation modalities have evolved towards responsive systems, such as autostimulation vagus nerve stimulation (VNS) and responsive neurostimulation, and non-invasive devices such as transcutaneous VNS and transcranial direct current stimulation; these have achieved similar decreases in seizure frequency to traditional neurostimulation in some studies. However, data for paediatric epilepsy are limited. Focused ultrasound is being developed not only for seizure focus ablation but also for other approaches to seizure control. In parallel with these developments, accumulating research in the areas of genetic testing, including genetic and related therapies designed to correct or compensate for underlying genetic causes of seizures, suggests that these technologies may have the potential to transform epilepsy treatment in the future. This review summarises major recent developments and current research in the treatment of epilepsy in children.