General Principles of the Medical Management of Epilepsy in Children: A Literature Review

The primary aim of epilepsy treatment is seizure control, and the treatment is principally prophylactic. Although complete seizure control is the most important predictor of improved quality of life, antiepileptic drugs (AEDs) could cause severe side effects in the patients. Therefore, the risk-benefit ratio must be considered before the initiation of AED treatment. Accurate recognition and differentiation of epileptic and non-epileptic paroxysmal events and the diagnosis of the seizure type and epilepsy syndrome are essential procedures before AED treatment. It is often recommended that AED treatment start after two seizures, and being seizure-free for a minimum of two years is a prerequisite for treatment withdrawal. The AED treatment process must be initiated with a single drug at a low maintenance dose, along with further upward titration. Overall, the first attempt in AED treatment has been reported to effectively control seizures in 50-70% of the cases. Moreover, there is a consensus that being seizure-free for two years is the most valid approach to discontinue AED treatment. Approximately 50% of the children with epilepsy outgrow their disease. The present study aimed to provide a systematic method for the treatment and management of epilepsy in children.