Current Treatment Options for Early-Onset Pediatric Epileptic Encephalopathies

Abstract

The management of early-onset, genetically determined epilepsies is often challenging. First-line anti-epileptic drugs (AEDs) often include phenobarbital, phenytoin, oxcarbazepine, carbamazepine, clonazepam, levetiracetam, and valproic acid. Combinations of medications are used in these patients with often intractable seizures, and they include topiramate, clobazam, felbamate, lacosamide, lamotrigine, rufinamide, vigabatrin, ACTH, oral steroids, and the ketogenic diet. Vagus nerve stimulator therapy offers some relief in selected patients. Surgical procedures, such as multiple subpial transections (MSTs), hemispherectomy, focal epilepsy surgery, or corpus callosotomy, may also be performed in selected patients. Careful monitoring of drug levels, if available, is highly recommended, as well as liver function tests, complete blood count, and electrolyte levels. AEDs often interact with each other, and the physician must be knowledgeable about such drug interactions, when selecting a new medication. In this article, the various encephalopathies are reviewed and presented according to age of onset of symptoms. Different treatment options are also summarized.

Keywords: Anti-epileptic drugs; Early-onset pediatric epileptic encephalopathy; Genetic epilepsy; Ketogenic diet; Newer anti-epileptic drugs; Vagal nerve stimulator.