Anti-Epileptic Drugs In Children

Drugs Of First Choice And Second Choice, And Third-Line Anti-Epileptic Drugs In Children

It should be ascertained in every child with medically refractory seizures that the drugs of first choice have been tried. For a discussion of drug choices related to seizure type and syndrome, see site.

In the daily practice of treating patients with seizures, one cannot avoid the process of selecting the next drug if the current drug is failing, even if satisfactory scientific evidence to support the choice is lacking. Accordingly, Table Evidence-based analysis of anti-epileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes provides data on which drugs have class I, II or III evidence for effectiveness, and Table Choice of anti-epileptic drugs in children by seizure type and syndrome summarizes, for various seizure types and syndromes, drugs that can be considered in patients who have remained refractory to first-and second-choice drugs. It should be emphasized that the choices listed in this table are a compromise, and that they are not based on scientific evidence and will always be open to debate. Also, over time, these treatment paradigms may suddenly or gradually change based on new information. Beyond the available knowledge regarding the spectrum of efficacy of various anti-epileptic drugs, safety and tolerability considerations as well as comfort factor are the main criteria used in the development of Table Choice of anti-epileptic drugs in children by seizure type and syndrome.

Table Evidence-based analysis of anti-epileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes (Glauser). Summary of studies and level of evidence for each seizure type and epilepsy syndrome.

Seizure type or epilepsy syndrome Class I Class II Class III Level of efficacy and effectiveness (alphabetical)
Children with partial-onset seizures

1

0

17

Level A: oxcarbazepine

Level B: None

Level C: carbamazepine, phenobarbital, phenytoin, topiramate, valproate

Children with generalized-onset tonic-clonic seizures

0

0

14

Level A: None

Level B: None

Level C: carbamazepine, phenobarbital, phenytoin, topiramate, valproate

Children with absence seizures

0

0

6

Level A: None

Level B: None

Level C: ethosuximide, lamotrigine, valproate

Rolandic epilepsy

0

0

2

Level A: None

Level B: None

Level C: carbamazepine, valproate

Juvenile myoclonic epilepsy

0

0

0

Level A: None

Level B: None

Level C: None

Table Choice of anti-epileptic drugs in children by seizure type and syndrome

Seizure type or syndrome First choice Second choice Consider
Partial seizures with / without secondary generalization oxcarbazepine, levetiracetam lamotrigine, gabapentin, valproate, topiramate, zonisamide phenobarbital, phenytoin, pregabalin
Generalized tonic-clonic valproate, lamotrigine, topiramate levetiracetam, carbamazepine, oxcarbazepine, phenytoin phenobarbital, zonisamide
Childhood absence ethosuximide, valproate lamotrigine methsuximide, levetiracetam, zonisamide, topiramate, acetazolamide
Juvenile absence valproate lamotrigine ethosuximide, methsuximide, levetiracetam, zonisamide, topiramate, acetazolamide
Juvenile myoclonic epilepsy valproate lamotrigine, levetiracetam, topiramate methsuximide, clonazepam, zonisamide
Infantile spasms adrenocorticotropic hormone, vigabatrin valproate, topiramate benzodiazepine, pyridoxine, lamotrigine, zonisamide, levetiracetam, ketogenic diet
Lennox-Gastaut syndrome valproate topiramate, lamotrigine ketogenic diet, felbamate, benzodiazepine, levetiracetam, zonisamide, phenobarbital, steroids
Benign rolandic epilepsy gabapentin, sulthiame valproate, levetiracetam lamotrigine, oxcarbazepine, benzodiazepine, ethosuximide, steroids, immunoglobulins

 

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