UPDATE ON EPILEPSY IN PEDIATRIC-PATIENTS

Epilepsy is a common condition that affects 0.5 to 1% of all children. Although most children with epilepsy have well-controlled seizures wi th use of one antiepileptic drug (AED), some children have medically r efractory seizures. This situation can be the result of inaccurate cla ssification of the paroxysmal event, use of an inappropriate AED, or a truly medically refractory seizure disorder. Paramount to the initial assessment of a child with presumed epilepsy is the appropriate class ification of the paroxysmal event. Several nonepileptic conditions, su ch as motor ties or breath-holding spells, can cause paroxysmal abnorm alities in children, which can be confused with epilepsy. The common p ediatric epileptic and nonepileptic conditions are reviewed, and the s tandard and new AEDs and their side effects are discussed. When a chil d's seizure disorder is intractable despite adequate trials of AEDs, s urgical treatment is increasingly becoming an effective option. Such p rocedures should ideally be performed at centers with extensive experi ence in this area and with a multidisciplinary team approach. With imp roved magnetic resonance imaging technology, increasing numbers of chi ldren with medically intractable localization-related epilepsy are bei ng found to have underlying focal cortical dysplasia, tumors, or hippo campal atrophy. These abnormalities can often be surgically resected w ith excellent results. A generalized epilepsy may also be remediable w ith surgical treatment. Specifically, preliminary data suggest that in fantile spasms, when triggered by an underlying focal cortical dysplas ia, may be effectively treated by surgical resection. Patients with ce rtain catastrophic seizure disorders, such as Sturge-Weber syndrome or hemimegalencephaly, require prompt intervention with hemispherectomy. The presurgical evaluation relies heavily on the magnetic resonance i maging, positron emission tomography, and single-photon emission compu ted tomography scan data as well as the electroencephalogram in identi fying the area of epileptogenic abnormality.