CHILDHOOD EPILEPSY - CURRENT THERAPEUTIC RECOMMENDATIONS

The pharmacotherapy of epilepsy in children must account for a number of specific issues. The nature of epileptic disorders found in childre n differs from that in adults. For example, epilepsies of childhood ar e more likely to be developmentally or genetically based than those fo und in adults. Children also differ from adults in indications for ant iepileptic drugs. Indeed, some types of childhood epilepsy do not requ ire specific pharmacological treatment since prognosis is often excell ent without therapy. This is especially true for children who are neur ologically normal and those with benign epilepsy syndromes that have a characteristic electroclinical presentation, such as febrile seizures . In contrast, children with evidence of brain damage or those with se rious epilepsy syndromes must be treated promptly. Once it has been de cided that treatment is necessary, the choice of treatment should be b ased on a comparison of efficacy and tolerability of individual antiep ileptic agents. The spectrum of toxicity is often different in younger patients from that in adults, and adverse effects that are acceptable in adults may be cause for discontinuation of therapy in children. In tellectual, cognitive and behavioural toxicity are particularly unacce ptable. Establishing sustained therapeutic serum concentrations in chi ldren also requires specific attention. Rapid gastrointestinal transit times and interactions with milk and infant formulas may pose special management problems. Toxic metabolites of antiepileptic drugs are fre quently produced in children. This can lead to drug hypersensitivity a nd other possible conditions, such as valproic acid (sodium valproate) -induced hepatotoxicity. Unless specific paediatric data are obtained, recommendations for the treatment of epilepsies in children will cont inue to be based on studies in adults and on anecdotal observations. G iven the high prevalence and significant morbidity of childhood epilep sies, further studies of treatments are urgently needed.