The rational use of antiepileptic drugs in children
Blaise F.D. Bourgeois, MD
Department of Neurology, The Cleveland Clinic Foundation, One Clinic Center, 9500 Euclid Avenue, Cleveland, Ohio 44195
A RATIONAL approach to the drug management of epilepsy in newborns, infants and children requires an understanding not only of the basic general rules of antiepileptic drug therapy, but also of the major differences between children and adults. Children with epilepsy differ from adults mainly because, first, they can present certain types of seizures or forms of epilepsy which are not seen in adults; second, because their epilepsy is a dynamic process whose response to therapy can change as maturation occurs; and third, because the pharmacokinetics of antiepileptic drugs are markedly affected by age. The questions that need to be answered when dealing with a child with seizures are when and for how long to treat, what drugs to use, and how to use them.
WHEN AND HOW LONG SHOULD A CHILD BE TREATED?
When considering the use of antiepileptic drugs in a child, every effort should be made to document the diagnosis of epilepsy, i.e., of recurrent spontaneous unprovoked epileptic seizures. Failure to do so may result in unnecessary chronic side effects and costs that can be associated with a daily medication over several years. Since normal electroencephalographic (EEG) recordings by no means rule out the epileptic nature of a paroxysmal clinical event, possible clues from the history or the physical examination indicating a lesion or a disease more likely to be associated with epilepsy should be sought carefully. If such evidence is found, neuroimaging studies may help to confirm the presence of a progressive or residual brain pathology.