The latest advances in the pharmacological management of focal epilepsies in children: a narrative review

ABSTRACT

Introduction

Focal epilepsy constitutes the most common epilepsy in children, and medical treatment represents the first-line therapy in this condition. The main goal of medical treatment for children and adolescents with epilepsy is the achievement of seizure freedom or, in drug-resistant epilepsies, a significant seizure reduction, both minimizing antiseizure medications (ASM)-related adverse events, thus improving the patient’s quality of life. However, up to 20–40% of pediatric epilepsies are refractory to drug treatments. New ASMs came to light in the pediatric landscape, improving the drug profile compared to that of the preexisting ones. Clinicians should consider several factors during the drug choice process, including patient and medication-specific characteristics.

Areas covered

This narrative review aims to summarize the latest evidence on the effectiveness and tolerability of the newest ASMs administered as monotherapy or adjunctive therapy in pediatric epilepsies with focal onset seizures, providing a practical appraisal based on the existing evidence.

Expert opinion

The latest ASMs have the potential to be effective in the pharmacological management of focal onset seizures in children, and treatment choice should consider several drug- and epilepsy-related factors. Future treatments should be increasingly personalized and targeted on patient-specific pathways. Future research should focus on discovering new chemical compounds and repurposing medications used for other indications.

KEYWORDS:

• Focal onset seizures
• children
• antiseizure medications
• perampanel
• brivaracetam
• cenobamate
• cannabidiol
• fenfluramine

Article highlights

• The main goal of the treatment of focal epilepsy in children is the achievement of seizure freedom or, in drug-resistant epilepsies, a significant reduction in seizure frequency, minimizing adverse events and improving quality of life.

• The newest ASMs recently approved or used off-label in pediatric focal onset seizures, highlighting how these new drugs should be considered promising based on the existing evidence.

• Major evidence is available for perampanel, which showed a significant effectiveness and safety in refractory focal onset seizures during developing ages.

• Brivaracetam and cenobamate could be valuable treatment options in the management of pediatric refractory focal onset seizures, exhibiting an excellent safety and tolerability profile with remarkable effectiveness.

• Cannabidiol and fenfluramine, approved for adjunctive treatment of specific developmental and epileptic encephalopathies, showed an overall favorable profile and good effectiveness; further studies could better clarify their role in focal pediatric epilepsies.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.