Treatment of pediatric epilepsy

Pediatric epilepsy is a neurological disorder arising from various etiologies, including structural, genetic, immune, infectious, metabolic, and unknown causes. Anti-seizure medications remain the primary treatment; however, in cases of drug-resistant epilepsy, surgical interventions, ketogenic diet, and emerging therapies have become increasingly effective options. Disease-modifying treatments, such as antisense oligonucleotides and adeno-associated virus-mediated gene replacement, have shown promise in some epilepsy treatments, with early trials reporting moderate seizure reduction. Minimally invasive surgical approaches, including magnetic resonance-guided laser interstitial thermal therapy, have also demonstrated favorable outcomes, showing a 68% seizure-free rate at 2 years in the largest pediatric series. Although the ketogenic diet is effective in some patients, demonstrating superiority over conventional management for >50% seizure reduction, long-term use may be associated with metabolic risks; careful monitoring is warranted. Future treatment strategies are expected to emphasize personalized medicine through the integration of genetic, electrophysiological, and neuroimaging data to optimize therapeutic decision-making and enable targeted interventions based on the underlying etiology.