DIAGNOSIS AND TREATMENT OF EPILEPSY IN CHILDREN AND ADOLESCENTS

Seizures have a variety of aetiologies and may have various manifestat ions. Some are recurrent and represent the different types of epilepsy , whereas others are isolated events. Descriptions of various epilepti c seizures, as well as their corresponding electroencephalograms (EEGs ), have recently led to a unifying international classification of epi leptic seizures and epilepsy syndromes. These classifications are extr emely important for the practitioner working with the paediatric patie nt, as they allow for optimal evaluation and treatment. This article r eviews the epilepsies and epilepsy syndromes with special attention to age of onset and prognosis. Special circumstances such as status epil epticus, which represents a true medical emergency, are reviewed. The first step in the pharmacological management of seizures is to establi sh the diagnosis of epilepsy. The recurrence of seizures (or the risk) , seizure type and specific syndrome help guide initial treatment choi ces. There is no drug of choice, but some drugs have proven more effec tive for certain types of seizure. Monotherapy is preferable, and comb ination therapy should only be used if monotherapy with first-line dru gs fails. Candidates for the newer antiepileptic drugs (e.g. felbamate , gabapentin, lamotrigine and vigabatrin) include patients resistant t o older agents or who are unable to tolerate them. The exact place in therapy of these newer agents is uncertain, but in many patients they provide better seizure control and are better tolerated.