Advancing pharmacologic treatment options for pharmacologic treatment options for children with epilepsy

ABSTRACT

Introduction: The pharmacological management of epilepsy is continually modified by the increase in our knowledge about the efficacy and the safety on antiepileptic drugs.

Areas covered: This review covers the published data (2010–2015) on the pharmacological management of epilepsy in children and adolescent. We review the data from the most recent randomized controlled and open-label trials.

Expert opinion: Even if there is an increasing number of antiepileptic drugs approved for focal seizure in children and adolescent with epilepsy, each new approval would be considered as a significant addition to the current therapeutic options. Refractory epilepsy with focal seizure should not be regarded as a single disease but as numerous various patients. Because most of evidence of efficacy is primarily from placebo-controlled trials, there is no evidence to choose a treatment based on efficacy. In case of focal seizure, we explain how possible cognitive impact, mechanisms of action, pharmacologic characteristics and side effect profile are the factors taken into an account to propose a treatment. In case of childhood absence epilepsy, there are evidences showing the ethosuximide should be the first line treatment. Finally, we stress that trials in the pediatric epilepsy syndromes are required to propose better evidence-based pharmacological management.

KEYWORDS:

• Antiepileptic drugs
• childhood absence epilepsy
• cognitive side effect
• ethosuximide
• perampanel
• polytherapy
• zonisamide

Article highlights

• Recent randomized controlled trials have established the efficacy of zonisamide (> 6 years) and perampanel (>12 years) for focal seizures.

• Several studies including a randomized controlled trial strongly support the use of ethosuximide as a first line in Childhood Absence Epilepsy.

• Recent data from randomized controlled trials and open studies in Lennox-Gastaut syndrome report the efficacy of rufinamide and clobazam for atonic/tonic seizures.

• Epilepsy syndromes in children are more than repetitive seizures. Multiple consequences including psychiatric comorbidities and intellectual disability are frequent and can be worsen by antiepileptic drugs.

• Data on antiepileptic drugs are missing in many pediatric epilepsy syndromes, in particular in young children and infants.

• The role of antiepileptic drugs on cognition and psychiatric comorbidities remains to be better explored.

This box summarizes key points contained in the article.

Declaration of interest

S Auvin has received honoraria for lectures or advices from Advicenne Pharma, Biocodex, EISAI, Novartis, Nutricia, Shire, Ultragenyx, UCB Pharma and Viropharma. The author has no other 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 apart from those disclosed.