[Role of physiopathological hypotheses in therapeutic choice in epilepsy in children]

Abstract

Choosing an anti-epileptic treatment is different in adults and in children. In children, it depends upon epilepsy syndromes and pathophysiological hypotheses may be helpful. In childhood absence epilepsy, vigabatrin is contraindicated because it induces worsening of absences by increasing the gabaergic inhibition, in children as in animal models. In infantile epilepsies, cerebral development is to be taken into account since functional maturation is still incomplete during the first years of life. In immature brain, focal epileptic discharges tend to generalize. Thus, in infantile spasms, seizures and EEG abnormalities are generalized although there can be a focal lesion. Such a diffuse hyperexcitability is resistant to antiepileptic drugs except to steroids, which decrease the brain level activity. When hyperexcitability is not so marked (spasms without hypsarrhythmia), vigabatrin has the best efficiency, as in spasms due to tuberous sclerosis that are controlled in more than 80 p. 100 of the cases by this drug. Persisting spasms are deleterious for cortical maturation and further cognitive development. Seizures of the first year of life could therefore considered as an emergency to treat, eventually by surgery in cases of focal or hemispheric malformation, before the development become impossible due to the epileptic phenomenon.