What are the considerations when initiating treatment for epilepsy in children?

ABSTRACT

Introduction

There is a very wide spectrum of epilepsies and developmental and epileptic encephalopathies that affect children, from self-limited forms, not necessarily requiring treatment, to severe drug-resistant ones.

Areas covered

In this perspective, the authors discuss the main factors to consider before drug prescription in children, considering the most recent clinical research, including age, seizure type, epilepsy syndrome, etiology, efficacy and safety profile, comorbidities, gender, available formulations, costs and drug coverage, and regulatory issues. The literature search was conducted through a PubMed search on antiseizure medications for patients aged 0–18, with respect to each of the aforementioned factors, and by checking the reference lists of relevant papers.

Expert opinion

The most expanding field of research and innovation for clinical practice is precision medicine, which addresses the holistic treatment of genetic epilepsies and developmental and epileptic encephalopathies. It achieves this by addressing their detrimental effects on synapses, neurotransmission, and cellular signaling pathways with the double aim to treat seizures and to rescue neurodevelopmental trajectories, but also the issue of adverse events and drug resistance through pharmacogenomics.

KEYWORDS:

• Antiseizure medications
• children
• developmental and epileptic encephalopathies
• drug therapy
• epilepsy
• precision medicine
• adverse events
• cognition

Article highlights

• Decision-making for infants and children with epilepsy is complex, the right prescription depending on multiple factors (age, gender, seizure type, epilepsy syndrome, etiology, efficacy, and safety profile of each antiseizure medication, comorbidities, available formulations, costs, drug coverage, and regulatory issues).

• Tailored therapies for each infant and children with epilepsy allow best efficacy and safety, and increase compliance.

• Additional, non-pharmacological strategies include epilepsy surgery, dietary therapies, and neuromodulation (including vagus nerve stimulation but also direct focal cortical stimulation).

• This field is facing a paradigmatic shift with the advent of precision medicine, although caution is needed in translating experimental (in vitro and in vivo results) to clinical practice.

• The possibility of gene therapy is also being explored in epilepsy models and definitely warrants attention.

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.