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Principles of Treatment of Epilepsy in Children and Adolescents 

Principles of Treatment of Epilepsy in Children and Adolescents
Chapter:
Principles of Treatment of Epilepsy in Children and Adolescents
Author(s):

Renzo Guerrini

DOI:
10.1093/med/9780199659043.003.0016
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date: 26 June 2022

Advances in clinical pharmacology, a better understanding of the molecular mechanisms involved in epileptogenesis, and a more precise diagnosis of the specific aetiologies and of epilepsy syndromes, have allowed more rational treatment choices. Knowledge of the main mechanisms of action and spectrum of efficacy of AEDs, and correct syndrome diagnosis are essential for rationale treatment. However, efficacy and safety data emerging from AED trials in children is difficult to interpret. In most trials, different epilepsy syndromes and etiologies are lumped together and the studies were not designed in general to detect worsening of seizures or specific reactions in different syndromes. Furthermore, finding that two or more drugs are equivalent when compared to one another on ‘newly diagnosed’ cases, does not rule out the possibility that all drugs are relatively ineffective and that spontaneous remissions or improvements significantly influence the results. Information on drug safety in children is scanty as AEDs are marketed for children only if they appear promising in adults, with considerable delay. Several treatment related issues are still widely debated because available evidence is incomplete or contradictory. These include when to start treatment, setting the targets for treatment, the cognitive and behavioural effects of antiepileptic drugs in children, syndrome specificity of drug response. Some of children who are refractory to antiepleptic drugs may benefit from surgical treatment and the benefits of early intervention have been emphasized. However, the average delay from seizure onset to surgery is too long.

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