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Management of Childhood Epilepsy

Glauser, Tracy A. MD; Loddenkemper, Tobias MD

CONTINUUM: Lifelong Learning in Neurology: June 2013 - Volume 19 - Issue 3, Epilepsy - p 656–681
doi: 10.1212/01.CON.0000431381.29308.85
Review Articles

Purpose of Review: This article outlines a diagnostic and management approach to pediatric seizures and epilepsy syndromes, and delineates pharmacologic and nonpharmacologic treatment options.

Recent Findings: Progress in tracking of seizures, identifying and addressing medication nonadherence, treatment with novel devices, and clinical decision support algorithms will provide additional management options in the future.

Summary: The management of pediatric seizures and epilepsies presents multiple challenges to the clinician because of nonepileptic imitators, evolving classification approaches, clinical presentations, limited clinical trial data for medications, and the toxicities of therapies. While certain pediatric seizures and epilepsy syndromes respond best to certain medications, early identification of pharmacologically resistant patients who may be candidates for epilepsy surgery is important. Alternative treatment options may include ketogenic diet or vagus nerve stimulation.

Address correspondence to Dr Tracy Glauser, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, ML2015, Cincinnati, OH 45229, Tracy.glauser@cchmc.org.

Relationship Disclosure: Dr Glauser serves as a consultant or speaker for Eisai Co, Ltd, GeneDx, Lundbeck, Questcor Pharmaceuticals, Inc, Sunovion Pharmaceuticals, Inc, Supernus Pharmaceuticals, Inc, UCB, and Upsher-Smith Laboratories, Inc. Dr Glauser receives royalty payments for a patent license from AssureRx Health, Inc, has received personal compensation for medical record reviews, and receives multiple grants from the NIH. Dr Loddenkemper serves on the American Board of Clinical Neurophysiology, the Council of the American Clinical Neurophysiology Society, and the Laboratory Accreditation Board for Long Term (Epilepsy and ICU) Monitoring (ABRET). Dr Loddenkemper serves as associate editor for Seizure—European Journal of Epilepsy and received investigator-initiated research support from Eisai and Lundbeck. Dr Loddenkemper receives research and funding support from the American Epilepsy Society, the Center for Integration of Medicine and Innovative Technology/Department of Defense, Children’s Hospital Boston, CURE: Citizens United for Research in Epilepsy, the Epilepsy Foundation of America, Epilepsy Therapy Project, Harvard Medical School, the NIH, and Translational Research Project.

Unlabeled Use of Products/Investigational Use Disclosure: Drs Glauser and Loddenkemper discuss the unlabeled use of epilepsy medications and epilepsy treatment options, all of which are limited to certain age ranges including infants and/or children.

© 2013 American Academy of Neurology