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  • Review Article
  • Published:

The challenges and innovations for therapy in children with epilepsy

Nature Reviews Neurology volume 10, pages 249–260 (2014)Cite this article

Subjects

Key Points

  • Information on the aetiology of epilepsies in children can be used to direct optimal treatments

  • Genetic analysis, neuroimaging and well-designed clinical trials can help to inform clinicians about therapeutic management of paediatric epilepsy

  • The availability of therapies and implementation of treatment guidelines differs between resource-poor and resource-rich countries

  • Comprehensive treatment options for paediatric patients with epilepsy should include antiepileptic drugs, a ketogenic diet, vagus nerve stimulation with surgery

  • Behavioural and cognitive problems frequently occur as comorbidities in children with epilepsy

Abstract

Major advances have been made in the diagnosis, evaluation and management of children with epilepsy over the past 15 years. There has been a marked increase in genetic diagnoses of a number of key childhood-onset epilepsy syndromes, such as Dravet syndrome, which has been linked to mutations in the SCN1A gene. The reorganization and reclassification of epilepsies, devised by the International League Against Epilepsy, has stimulated specialists to reassess their diagnostic practices; however, many studies have not addressed the global issues in treating children with epilepsy—specifically, the challenges of diagnosis through to optimal, and appropriate, therapeutic management. Also, Class I evidence-based data that are needed as a foundation for the development of treatment guidelines worldwide are lacking. Epilepsy is common, and the impact of this disease crosses age ranges and should be managed at all levels of care from community to quaternary care. In this Review, existing data and new therapeutic management approaches are discussed with the aim of highlighting the incidence of standard practices that may not be based on clinical evidence.

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Figure 1: Illustration of the mechanism for closed-loop systems.

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Authors and Affiliations

  1. Red Cross War Memorial Children's Hospital, University of Cape Town, Rondebosch, 7700, South Africa

    Jo M. Wilmshurst

  2. Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Chicago, 60611, IL, USA

    Anne T. Berg

  3. Department of Pediatric Neurology, University Hospitals Leuven, Herestraat 49, Leuven, 3000, Belgium

    Lieven Lagae

  4. Centre for Geographic Medicine Research–Coast, Kenya Medical Research Institute, PO Box 230, Kilifi, 80108, Kenya

    Charles R. Newton

  5. UCL Institute of Child Health, 4/5 Long Yard, London, WC1N 3LU, UK

    J. Helen Cross

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J.M.W., A.T.B. and J.H.C. researched the data for the manuscript, and reviewed and edited the manuscript before final submission. J.M.W., A.T.B., L.L. and J.H.C. provided substantial contributions to discussion and writing of the content. C.R.N. contributed to writing of the article.

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Wilmshurst, J., Berg, A., Lagae, L. et al. The challenges and innovations for therapy in children with epilepsy. Nat Rev Neurol 10, 249–260 (2014). https://doi.org/10.1038/nrneurol.2014.58

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