Moving beyond sodium valproate: choosing the right anti-epileptic drug in children

ABSTRACT

Introduction: Sodium valproate is a widely used anti-epileptic drug with a broad spectrum of activity and mechanism of action. It has consequently been the first-line drug for most seizure types in children for the past fifty years. A wide range of side effects come along with these exceptional properties, including teratogenicity and neuro-cognitive impairments in offspring. Therefore, epilepsy treatment in children and adolescents should be reassessed in light of newer antiepileptic drugs as well as a more targeted-approach with older drugs.

Areas covered: The authors review the main concerns of valproate use in terms of adverse effects on different systems and drug interactions. The current alternatives to valproate in absence, myoclonic, tonic-clonic and focal onset seizures in children/adolescents are also reviewed.

Expert opinion: There are several issues that research should address in antiepileptic therapy and in clinical studies with children, given the peculiarity of this population. Future perspectives in epilepsy therapy should now lead towards an individualized treatment.

KEYWORDS:

• Epilepsy
• children
• therapy
• valproate
• antiseizure drugs
• adverse effects

Article highlights

• Valproate remains one of the most widely used AED, due to its different mechanisms of action and broad spectrum of activity for several seizure types

• Alongside its properties, VPA carries a wide range of adverse events and it is very prone to drug interactions

• Valproate should still be considered, although carefully, in female paediatric/adolescent patients as a therapeutic option in seizures carrying a high morbidity and mortality rate

• Several new pharmacological options are available to move beyond valproate in different seizure types and valproate derivatives are in development

• Randomized controlled clinical trials and prospective studies are still lacking in the paediatric population and would be of major benefit in choosing the AED therapy

• Individualized therapy should be the goal in antiepileptic treatment and future studies will bring new tools to implement a patient-based approach in epilepsy

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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 manuscript was not funded.