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Neurology supplements are not peer-reviewed. Information contained in Neurology supplements represent the opinions of the authors and are not endorsed by nor do they reflect the views of the American Academy of Neurology, Editor-in-Chief, or Associate Editors of Neurology.

Initial treatment of epilepsy with antiepileptic drugs

Pediatric issues

From the David Geffen School of Medicine and Mattel Children’s Hospital at the University of California Los Angeles, California.

Address correspondence and reprint requests to Dr. Raman Sankar, David Geffen School of Medicine and Mattel Children’s Hospital at UCLA, Room 22–474 MDCC, UCLA Medical Center, Los Angeles, CA 90095-1752; e-mail: RSankar{at}ucla.edu

The selection of an antiepileptic drug (AED) for initial treatment of epilepsy in infancy, childhood, and adolescence should ideally be made after a clear syndromic diagnosis of the patient’s seizure disorder. A common cause of failure of the first AED is erroneous diagnosis. The availability of new-generation AEDs has expanded the choice of available agents with comparable efficacy for most syndromes. Efficacy data based on class I or II evidence are not available for many syndromes of childhood, and selection must therefore be based on the best data available. It is also important to assess the relative toxicity and tolerability of AEDs in making the selection. It is especially important to appreciate age-specific organ toxicities. Moreover, the use of AEDs in childhood requires an understanding of their neurobehavioral effects. Important neuropsychiatric co-morbidities in children with epilepsy include attention deficit/hyperactivity disorder, autistic spectrum disorders, depression and anxiety, and thought disorders. These problems can be exacerbated or ameliorated by specific AEDs. The effect of AEDs on body weight, insulin sensitivity, lipid profile, and bone health is becoming better appreciated. Newer AEDs may offer significant advantages in this regard. Co-morbid migraine in children with epilepsy may benefit from some AEDs. There remains a continuing need for the development of newer AEDs that are targeted for the developing brain to improve the efficacy and tolerability of treatment in childhood seizure disorders.

Publication of this supplement was supported by an unrestricted educational grant from GlaxoSmithKline. The sponsor has provided R.S. with an honorarium for his participation in this project. He has also received other honoraria from the sponsor during his career.

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