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Diagnosis and treatment of epilepsy in children and adolescents
1Division of Child Neurology, Medical College of Virginia, Richmond, USA.
Insights
This review discusses the classification, evaluation, and treatment of epilepsy and epileptic seizures, emphasizing age-specific factors and prognosis. It highlights the importance of accurate diagnosis for guiding pharmacological management, including newer antiepileptic drugs.
Area of Science:
- Neurology
- Clinical Neuroscience
- Pharmacology
Background:
- Seizures present with diverse etiologies and manifestations, ranging from isolated events to recurrent epileptic seizures.
- Recent advancements include a unifying international classification of epileptic seizures and epilepsy syndromes based on electroencephalogram (EEG) data.
- Accurate classification is crucial for effective evaluation and treatment, particularly in pediatric patients.
Purpose of the Study:
- To review epilepsies and epilepsy syndromes, focusing on age of onset and prognosis.
- To discuss the management of special circumstances like status epilepticus, a medical emergency.
- To outline the principles of pharmacological management for seizures and epilepsy.
Main Methods:
- Review of existing literature on epilepsy classification, diagnosis, and treatment.
- Emphasis on age-specific considerations and prognostic factors.
- Discussion of pharmacological strategies, including monotherapy, combination therapy, and newer antiepileptic drugs.
Main Results:
- The classification of epileptic seizures and syndromes aids practitioners in optimal patient evaluation and treatment.
- Pharmacological management begins with establishing an epilepsy diagnosis, guiding treatment choices by seizure recurrence risk, type, and syndrome.
- Newer antiepileptic drugs offer potential benefits for patients resistant to or intolerant of older agents, with improved seizure control and tolerability in many cases.
Conclusions:
- Effective management of epilepsy relies on accurate diagnosis and classification.
- Treatment strategies should be tailored to seizure type, syndrome, and patient-specific factors.
- Newer antiepileptic drugs represent valuable additions to the therapeutic armamentarium for difficult-to-treat epilepsy cases.
Abstract:
Seizures have a variety of aetiologies and may have various manifestations. Some are recurrent and represent the different types of epilepsy, whereas others are isolated events. Descriptions of various epileptic seizures, as well as their corresponding electroencephalograms (EEGs), have recently led to a unifying international classification of epileptic seizures and epilepsy syndromes. These classifications are extremely important for the practitioner working with the paediatric patient, as they allow for optimal evaluation and treatment. This article reviews the epilepsies and epilepsy syndromes with special attention to age of onset and prognosis. Special circumstances such as status epilepticus, which represents a true medical emergency, are reviewed. The first step in the pharmacological management of seizures is to establish the diagnosis of epilepsy. The recurrence of seizures (or the risk), seizure type and specific syndrome help guide initial treatment choices. There is no drug of choice, but some drugs have proven more effective for certain types of seizure. Monotherapy is preferable, and combination therapy should only be used if monotherapy with first-line drugs fails. Candidates for the newer antiepileptic drugs (e.g. felbamate, gabapentin, lamotrigine and vigabatrin) include patients resistant to older agents or who are unable to tolerate them. The exact place in therapy of these newer agents is uncertain, but in many patients they provide better seizure control and are better tolerated.