Epilepsy in Childhood

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Abstract
TREATMENT strategies in childhood epilepsy are not simple and uniform. There is no universally applicable standard of treatment. Many unproved assumptions influence treatment decisions and may confound the perspective on important questions regarding the treatment of epilepsy. Publications that propose an algorithm of treatment in childhood epilepsy disagree on many issues. A basic point of discussion involves which children with seizures should be treated. It has been suggested that children with a first single seizure should not be treated, but children with few or minor seizures may not need treatment with antiepileptic drugs (AEDs) either.1- 3 It is not known what proportion of children can safely be left without treatment. When treatment is considered appropriate, only global guidelines are available to aid AED selection, although physicians may hold strong individual opinions.4 Specific recommendations for treatment are only given for some specific seizure types, such as absences, infantile spasms, and myoclonic or atonic seizures.5 There is no evidence that indicates how to treat patients who fail to respond to an adequate first AED regimen, although most authors agree that for first- and second-choice therapy, monotherapy is generally preferable to polytherapy.6- 9 The usefulness of polytherapy, the correct moment to initiate it, and what combinations of AEDs to use are still matters of opinion rather than of comparative evidence.7,10 At some point, when a number of AEDs have failed to provide complete control of seizures and when the consequences of seizures are not acceptable, the epilepsy can be classified as intractable. However, many different definitions to identify children with "intractable epilepsy" are being used. Most researchers11,12 use operational criteria based only on seizure frequency or lack of remission. The essence of the concept of intractable epilepsy, however, is failure to bring seizures under "acceptable control."13,14