CARE OF CHILDREN WITH EPILEPSY

Treating epilepsy in children is different from treating epilepsy in a dults. Unique epilepsy syndromes, drug pharmacokinetics and unique tre atments all contribute to the challenges involved in treating children with epilepsy. Even when the same drug is used to treat the same type of seizure, there are differences in drug pharmacokinetics, adverse e vents, and dosing schedules and formulations. Choosing an effective an tiepileptic drug (AED) is further complicated by the fact that the new er AEDs often are tested only in adults, thereby creating an informati on gap regarding drug treatment for children. Some epilepsy syndromes occur only in children, whereas others persist into adulthood. Some ep ilepsy syndromes and seizure types are benign and amenable to treatmen t, whereas others are more serious and often refractory to treatment. Seizure types and presentations vary, as does use of resources. About half of all patients with complex partial seizures, the most common se izure type, have childhood onset. School and behavioral problems are c ommon in children with these seizures, as are accidents, injuries, and stigmatization. Such children should be evaluated by a neuropsycholog ist who can help devise an educational strategy and behavior modificat ion plan if necessary. Two epilepsies, West syndrome and Lennox-Gastau t syndrome, deserve special attention, not only for their severity and poor outcomes but also for their disproportionate use of resources an d profound impact on the quality of life. Although the introduction of newer AEDs offers some hope for better seizure control, experience wi th these drugs in children is limited, largely because they are not in dicated for this age group. As with all drugs, the risks should be wei ghed against the benefits before initiating treatment with any of thes e agents. The ketogenic diet is again being considered as a form of ep ilepsy treatment in children whose seizures are refractory to therapy with AEDs. This medically prescribed diet is initiated in the hospital with a fast to deplete the child's glucose and carbohydrate reserves and induce ketosis in an effort to control the child's seizures. Once the child is ketotic, the high-fat, very-low-carbohydrate, low-protein diet is begun. The diet is designed by a registered dietitian and cal culated specifically for the child, based on his or her age, body weig ht, and activity level. The third option for children with refractory seizures is a surgical procedure. This could include traditional epile psy surgery on the brain or vagus nerve stimulation. Whatever treatmen t modality is chosen for the child with epilepsy, it should be directe d not only toward seizure control itself but also toward resolving the problems associated with epilepsy.