Treatment Of Epilepsy In Children Research Articles

Cognitive outcomes following frontal lobe resection for treatment of epilepsy in children and adolescents

ObjectiveTo use reliable change indices (RCIs) developed specifically for pediatric patients with epilepsy to examine cognitive outcomes after frontal lobe resection for pharmacoresistant epilepsy. MethodsForty-one pediatric patients (25 male, Mage = 10 years) completed comprehensive neuropsychological evaluations before and an average of 6.5 months after frontal lobe resections for treatment of epilepsy. Evaluations included tests of intelligence, attention/working memory, processing speed, language, visuospatial skills, executive function, and episodic memory. Practice effect-adjusted RCIs were used to determine clinically significant postoperative cognitive change. Demographic, disease, and surgical variables were examined to identify factors associated with postoperative cognitive decline or improvement. ResultsWithin each cognitive domain, there was a large proportion of patients (51–84%) who did not exhibit significant cognitive change. In terms of overall cognitive profile, 44% demonstrated improvement in at least one domain and 69% declined in at least one domain. Postoperative cognitive improvement occurred most commonly in the domain of processing speed, whereas postoperative cognitive decline occurred most frequently in the domain of visuospatial skills. Younger age at surgery was associated with cognitive improvement. Older age at seizure onset and higher baseline cognitive performance were associated with cognitive decline. SignificanceApproximately 6.5 months after frontal lobe resection, only 15% of our sample showed stable performance across all cognitive domains. Seventeen percent of patients showed improvements without declines, 42% showed declines without improvements, and 27% showed a mix of improvements and declines across different cognitive domains. Age and baseline abilities were associated with postoperative cognitive change on multiple measures. With 1 in 8 children demonstrating postoperative decline across three or more domains, further research is needed to identify factors associated with cognitive decline in order to inform clinical decision-making and patient/family counseling.

Epilepsy and cannabidiol - a new perspective for seizures treatment

BACKGROUND: Despite the fact that the number of antiepileptic drugs is constantly increasing, epilepsy can still be a therapeutic challenge. Approximately one-third of patients with epilepsy have persistent seizures refractory to treatment. The limited number of effective alternatives motivates researchers to seek new solutions. There is some hope for cannabidiol (CBD) preparations.AIM OF THE STUDY: The purpose of this study was to review the most recent available literature on the use of cannabidiol in the treatment of refractory epilepsy in children and adults. For this purpose, the PubMed and Google Scholar databases were reviewed. The phrase "cannabidiol and epilepsy" was used to search the database. After Screening titles and abstracts a total of 19 papers and articles cited in them were received and analyzed in detail. RESULTS: Nowadays there are many CBD related products available in the market, Cannabis sativa and Cannabis indica are the plants used due to their strong therapeutic effects and also seizure control. Regulations regarding the use of raw marijuana, cannabis extracts, and cannabinoid-based drugs vary from place to place. Many studies have been generated on the efficacy of cannabinoid therapy in the treatment of epilepsy. This therapy in patients with Dravet syndrome and Lennox-Gaust syndrome results in a reduction in the frequency of motor and total seizures. The most commonly reported side effects of CBD are drowsiness, seizures and diarrhea, but the therapy is generally well tolerated.SUMMARY AND CONCLUSIONS: Many available studies support the efficacy of CBD as a treatment option to reduce seizure frequency in children with drug-resistant epilepsy, particularly in patients with Dravet and Lennox-Gastaut syndrome. However, there is a lack of reports on the use of CBD in the adult population, which may be an area for further research.

Research progress of nerve stimulation in the treatment of epilepsy in children

Research progress of nerve stimulation in the treatment of epilepsy in children

English

BACKGROUND Though epilepsy remains a significant problem for children and adolescents in our country, studies delineating the clinical profile and response to treatment in childhood epilepsy are lacking. The current study was carried out for obtaining a baseline profile and to predict the response to treatment in childhood epilepsy in India that may be helpful in planning management strategies from a public health point of view. METHODS Patients with clinical suggestion of active epilepsy (N = 141) from one month to 12 years, were enrolled into the study over a period of 1 year (February 2010 to January 2011) from the out-patient department and epilepsy clinic of Bangur Institute of Neurology. Detailed history was taken along with neurological examination. Electroencephalography (EEG) and neuroimaging (MRI / CT scan) were done on all patients. Each patient included in the study was kept in followup for a period of 6 months and their response to the treatment was recorded. RESULTS About 48.9 % (N = 69) patients had localisation related epilepsy while the rest had generalised epilepsy. Of those with generalised epilepsy, generalised tonicclonic seizures (GTCS) was by far the most common type. Of those with focal EEG activity, the highest proportion (50 %), were localised to the temporal lobe. Symptomatic aetiology accounted for 59.6 % (N = 84) of the patients. 20.6 % (N = 29) had poor response to treatment at 6 months follow-up. Abnormal neuroimaging (OR = 6.708) and abnormal EEG (OR = 6.357) were effective factors in predicting poor response to treatment. CONCLUSIONS Our study highlights the need to link specialised epilepsy services with primary health centres for early detection and treatment. EEG is an essential cost-effective modality in determining seizure localisation and response to treatment. KEYWORDS Paediatric, Epilepsy, Clinical Profile, Response to Treatment

Pharmacoepidemiology of Antiepileptic Drugs in Children

With the pharmacotherapy of epilepsy, there is a decrease in the number of seizures or their complete cessation. The aim of the study was to conduct a comparative analysis of the efficacy and safety of antiepileptics traditionally used in medicine (valproate, carbamazepine) and new-generation analogs (topiramate) in the treatment of epilepsy in children and adolescents. The study was conducted in 2014 and 2018, at the Center for Epileptology and Neurology, Moscow (Russian Federation). In 2014, 777 medical records of children registered with epilep¬tologists were studied, in 2018 - 840 medical records of children. The age interval of 3 months is 18 years. Favorable outcomes of epilepsy therapy with different drugs were calculated, with different approaches monotherapy and polytherapy. A favorable outcome meant remis¬sion, which lasted more than 1 year and more than 3 years. In 2014 and 2018, monotherapy prevailed among the treatment methods. With monotherapy, valproates are used more often (up to 70%), carbamazepine is used 3.0 times less often (p ≤ 0.01 relative to valproates). The use of topiramate is 10 times less than the number of valproate therapy (p ≤ 0.0001), and barbiturates - 15 times (p ≤ 0.0001). Among the new gen¬eration drugs, topiramate was often used, with monotherapy, with symptomatic forms of epilepsy (10.4% in 2014 and 7.9% in 2018, p ≤ 0.05), as well as with a cryptogenic form (9.6% and 4.4%, respectively, p ≤ 0.05). The chosen type of therapy can significantly affect the number of side effects. With polytherapy, in 2014, side effects were observed in 44.1% compared with monotherapy (18.1%, at p ≤ 0.01), in 2018 - 45.1% against 20.9% (at p ≤ 0.01). Topiramate showed lower efficacy compared with carbamazepine in all years of the study with monother¬apy (0.65, at p ≤ 0.04). The results did not confirm the effectiveness of the new drugs. There was no difference in efficacy and safety between traditional drugs (valproate, carbamazepine) and new generation drugs (topiramate and others). In 2014 and 2018, monotherapy (72.8%) over polytherapy (27.2%) prevailed among the treatment methods for epilepsy. Among the drugs, valproate was predominant (65.8%), and in all identified forms of epilepsy. The new generation of drugs did not show statistically significant advantages compared to traditionally used ones. The method of polytherapy of epilepsy in children gives a twofold increase in the likelihood of side effects (p ≤ 0.01).

Does levetiracetam use affect visual evoked potentials in the treatment of childhood epilepsy?

Side effects of antiepileptic drugs vary depending on the drug itself, drug dose and duration of use. One of these side effects is related to vision. Patients who had been ordered visual evoked potential (VEP) measurements for various reasons between October 1st, 2017 and October 1st, 2019 at a pediatric neurology outpatient clinic and who were on levetiracetam monotherapy for at least six months for the treatment of focal/generalized epilepsy were included in the study and their files were scanned retrospectively (study group: SG). Patient files were evaluated for age, gender, dose and duration of levetiracetam use, presence of a family history of epilepsy, EEG result, cranial magnetic resonance imaging and VEP test results and the parameters were recorded. Twenty-four patients of similar age range without epilepsy were included in the study as the control group (CG). Eighteen patients 8 boys (44.4%), 10 girls (55.6%) and 24 healthy controls 9 boys (37.5%), 15 girls (62.5%) were included in the study and control groups, respectively. No statistically significant difference was found when the mean VEP latencies were compared between the patient and control groups for the right (P=0.451) and left (P=0.323) eyes. There was a statistically significant difference between the groups, respectively, when VEP amplitudes of the right and left eyes of the SG and CG were compared (P=0.001; P=0.001). There is no correlation between levetiracetam dose and duration of treatment and VEP parameters. The data obtained in this study showed that levetiracetam use affected VEP amplitude outcome but did not affect VEP latency outcome in pediatric patients.

Efficacy and tolerability of perampanel as adjunctive treatment of focal and generalized tonic-clonic epileptic seizures in children over 4 years of age

The article is a short review of an observational study that proves the good efficacy and tolerability of perampanel suspension in the adjunctive treatment of epilepsy in children over 4 years of age. The study demonstrated a high level of 50% responders: 47% with focal seizures, 65% with transition of focal seizures to bilateral tonic-clonic seizures, 65% with primary generalized tonic-clonic seizures. Cessation of seizures was achieved in 12%, 19% and 55% of patients, respectively. The most common side-effects were fatigue (26%), nasopharyngitis (19%), lightheadedness, irritability, fever (13% each), and vomiting (11%). There were no significant clinical negative changes in cognitive functions according to the assessment on the Aldenkamp-Baker scale, both on the total score and subscales. Also, there were no significant changes in laboratory data, vital functions and ECG parameters.

Determination of healthcare resource and cost implications of using alternative sodium valproate formulations in the treatment of epilepsy in children in England: A retrospective database review

ObjectivesThe aim of this study was to compare the adherence, healthcare resource and cost implications of using Episenta® minitablets or Epilim® monolithic tablet in the treatment of epilepsy in children in England. DesignThis is a retrospective analysis of healthcare administrative databases. SettingThe study analysed data collected from Primary Care (Clinical Practice Research Datalink (CPRD)) and Secondary Care (Hospital Episode Statistics (HES)) in England, UK. ParticipantsPatients (stratified by age 0–12; 0–17 and 18+ years) with a diagnosis of epilepsy in receipt of a new prescription for Episenta® minitablets or Epilim® monolithic tablet from January 2012 to October 2017. Limited to those with a minimum of 12 months follow-up. Main outcome measuresDetermining the impact of sodium valproate formulation on measures of treatment adherence and healthcare resource usage. ResultsThere were 793 patients in the dataset: 84 on Episenta® minitablets and 709 on Epilim® tablets. Measures of medication adherence were not significantly different between the minitablet formulation and the monolithic matrix tablet. However there was a greater annualised incidence rate of epilepsy related primary healthcare contacts in a paediatric population from the tablet formulation compared to those treated with minitablets (95% CI [−1.561,0.0152]) for those aged 0–12 and (95% CI [−1.3234,−0.0058]) for those aged 0–17. This is found despite a lower dose being used in the minitablet cohort (595 mg vs 945 mg for the tablet) for those aged 0–17 which indicates effective therapy at a lower dose using the minitablet compared to the monolithic tablet formulation. ConclusionsMinitablet formulations of sodium valproate (presented as granules in capsules or sachets) can provide better therapeutic outcomes and reduced associated healthcare resource costs compared to monolithic tablets in children and young people with epilepsy. The interpretation of this data is limited by the large difference in sample size between the two groups which needs additional investigation to generate matched data for future comparisons. Further work is required to understand why the Episenta® minitablets formulation generated better outcomes in paediatric populations.

Ketogenic diet: A nutritional remedy for some metabolic disorders

Background: Ketogenic diets (KD) consist of high fat, moderate protein and low carbohydrates.Aim: This review explores the effect of ketogenic diet and its mechanism of actions in disease management.Methods: Recent information on ketogenic diets and disease management were retrieved from academic journals using scientific search engines and popular library databases such as PubMed, Scopus, Web of Science, JSTOR amongst others.Commentary: Ketogenic diet means a high fat, low-carbohydrate diet, with enough protein content, which makes the body utilize fat, rather than carbohydrate, as a preferred energy source. There are four different types of ketogenic diet, the traditional classic ketogenic diet, medium chain triglyceride (MCT) ketogenic diet, the modified Atkins diet (MAD), and the low glycemic index treatment (LGIT). The classic ketogenic diet, also known as long-chain fats consist of 16-20 carbon atoms. Its peculiarity is the low carbohydrate content, which could be difficult to maintain. The MCT was developed as an alternative to classic ketogenic diet. It has a fat composition of 60% octanoic acid (eight-carbon fatty acid) and 40% decanoic acid (10-carbon fatty acid). The MCT provides about 45% of energy when compared with the classic ketogenic diet. The MAD though strongly encourages the intake of high fat, it allows for 10-20 g of carbohydrate per day. The LGIT permits only low glycemic index foods. Ketogenic diets have been a therapeutic strategy for several diseases such as obesity, dyslipidemia, cancer and a broad range of neurological disorders.Conclusion: The ketogenic diet, an effective and age-long treatment for epilepsy in children, is gradually gaining acceptance as a therapeutic modality for many other diseases.

Quality of Life in Children with Epilepsy in Wah Cantt, Pakistan: A Cross-sectional Study

Objective: To assess the Quality Of Life (QOL) in children with epilepsy using modified QOLCE-55 questionnaire.
 Material and Methods: We consecutively enrolled children aged 4 to 16 years who were under treatment for childhood epilepsy. Basic demographic and clinical details including type of epilepsy, developmental history, family history of epilepsy and any co-morbidity were recorded in a predesigned Performa. QOL was evaluated by using modified QOLCE-55 (39 items) from parents.
 Results: A total of 54 children were enrolled in the study, 42 (78%) were males and 12(22%) were female children with epilepsy. Eight children got good QOLCE score, while 24 children had average and 22 children got a poor score. The good score was mostly seen in 4-8 years (40%) of age while the poor score was seen in 12-16 years (70%) age group. Age of the patients (p=<0.001), gender (p=<0.001), associated co-morbidities (p=0.003) and family history of epilepsy (p=0.011) showed a significant effect on the QOLCE score. Type of epilepsy (p= 0.825) and development of a child (p=0.109) did not affect the QOLCE score significantly.
 Conclusion: The study showed that Children with co-morbidities, family history of epilepsy and female children of older age group (12-16 years) had poor QOL. Types of seizures and development of the child did not significantly alter the QOLCE score.

Is clobazam monotherapy effective and safe in people with focal or generalized seizures? A Cochrane Review summary with commentary

Is clobazam monotherapy effective and safe in people with focal or generalized seizures? A Cochrane Review summary with commentary

Cannabis Treatment in Children with Epilepsy: Practices of Canadian Neurologists.

Medical cannabis has recently emerged as a treatment option for children with drug-resistant epilepsy. Despite the fact that many pediatric epilepsy patients across Canada are currently being treated with cannabis, little is known about the attitudes of neurologists toward cannabinoid treatment of children with epilepsy. A 21-item online survey was distributed via email to 148 pediatric neurologists working in hospitals and community clinics across Canada. Questions were related to clinical practice and demographics. This survey achieved a response rate of 38% (56 Canadian neurologists). These neurologists were treating 668 pediatric epilepsy patients with cannabinoids. While 29% of neurologists did not support cannabis treatment in their patients, 34% prescribed cannabis, and 38% referred to another authorizing physician, mostly to community-based non-neurologists. The majority of neurologists considered cannabis for patients with Dravet syndrome (68%) and Lennox-Gastaut syndrome (64%) after an average of three failed anticonvulsants. Twenty-seven percent considered it for patients with idiopathic generalized epilepsy, and 18% for focal epilepsy. No neurologist used cannabis as a first-line treatment. All neurologists had at least one hesitation regarding cannabis treatment in pediatric epilepsy. The most common one was poor evidence (66%), followed by poor quality control (52%) and high cost (50%). The majority of Canadian pediatric neurologists consider using cannabis as a treatment for epilepsy in children. With many gaps in evidence and high patient-driven demand for cannabis therapy, this survey provides immediate information from the "wisdom of the crowd," to aid neurologists until further evidence is available.

Clinical evaluation of reconstruction and acquisition time for pediatric 18F-FDG brain PET using digital PET/CT.

18F-2-fluoro-2-deoxyglucose (FDG) positron emission tomography (PET) plays an important role in the diagnosis, evaluation and treatment of childhood epilepsy. The selection of appropriate acquisition and reconstruction parameters, however, can be challenging with the introduction of advanced hardware and software functionalities. To quantify the diagnostic performance of a block-sequential regularized expectation maximization (BSREM) tool and reduced effective counts in brain PET/CT for pediatric epilepsy patients on a digital silicon photomultiplier system. We included 400 sets of brain PET/CT images from 25 pediatric patients (0.5-16years old) in this retrospective study. Patient images were reconstructed with conventional iterative techniques or BSREM with varied penalization factor (β), at varied acquisition time (45s, 90s, 180s, 300s) to simulate reduced count density. Two pediatric nuclear medicine physicians reviewed images in random order - blinded to patient, reconstruction method and imaging time - and scored technical quality (noise, spatial resolution, artifacts), clinical quality (image quality of the cortex, basal ganglia and thalamus) and overall diagnostic satisfaction on a 5-point scale. Reconstruction with BSREM improved quality and clinical scores across all count levels, with the greatest benefits in low-count conditions. Image quality scores were greatest at 300-s acquisition times with β=500 (overall; noise; artifacts; image quality of the cortex, basal ganglia and thalamus) or β=200 (spatial resolution). No statistically significant difference in the highest graded reconstruction was observed between imaging at 180s and 300s with an appropriately implemented penalization factor (β=350-500), indicating that a reduction in dose or acquisition time is feasible without reduction in diagnostic satisfaction. Clinical evaluation of pediatric 18F-FDG brain PET image quality was shown to be diagnostic at reductions of count density by 40% using BSREM with a penalization factor of β=350-500. This can be accomplished while maintaining confidence of achieving a diagnostic-quality image.

Assessment and treatment of childhood epilepsyin Haiti.

ObjectiveThe global burden of pediatric epilepsy is disproportionately concentrated in low‐ and middle‐income countries (LMICs). However, little is known about the effectiveness of current treatment programs in this setting. We present the outcomes of children who were assessed and treated at the Clinique D'Épilepsie de Port‐au‐Prince (CLIDEP), the only pediatric epilepsy referral center in Haiti.MethodsA 10‐year retrospective review of children consecutively assessed and treated at CLIDEP was performed. The primary outcome was seizure control following treatment for epilepsy. The secondary outcome was an accurate determination of the diagnosis of epilepsy. A data‐driven principle component regression (PCR) analysis was used to identify variables associated with outcomes of interest.ResultsOf the 812 children referred for evaluation, most children (82%) underwent electroencephalography to investigate a possible epilepsy diagnosis. Very few children (7%) underwent cranial imaging. Although many patients were lost to follow‐up (24%), most children who returned to clinic had less frequent seizures (51%) and compliance with medication was relatively high (79%). Using PCR, we identified a patient phenotype that was strongly associated with poor seizure control which had strong contributions from abnormal neurological examination, higher number of antiepileptic drugs, comorbid diagnoses, epileptic encephalopathy or epilepsy syndrome, and developmental delay. Head circumference also contributed to epilepsy outcomes in Haiti with smaller head sizes being associated with a poor seizure outcome. A dissociable phenotype of febrile seizures, suspected structural abnormality, epileptic encephalopathy or epilepsy syndrome, and higher seizure frequency was associated with a diagnosis of epilepsy.SignificanceWe describe the current landscape of childhood epilepsy in Haiti with an emphasis on diagnosis, treatment and outcomes. The findings provide evidence for the effectiveness of programs aimed at the diagnosis and management of epilepsy in LMICs and may inform the allocation of resources and create more effective referral structures.

Surgical treatment of epilepsy in children with focal cortical dysplasia

Surgery is the first-line treatment option in children with FCD and refractory epilepsy, but the rate of success and patient numbers who became free of seizures vary widely from series to series. To elicit variables affecting the outcome and predicting achievement of the long-term seizure-free status. One hundred sixty-nine children with cortical dysplasia and DR-epilepsy underwent surgery Preoperative evaluation included prolonged video-EEG and MRI (in all patients) and neuropsychological testing when possible. Fourteen patients underwent invasive EEG, fMRI and MEG were used also in some cases. Including 27 repeat procedures the list of overall 196 surgeries performed consists of: cortectomy (lesionectomy with or without adjacent epileptogenic cortices) – in 116 cases; lobectomy – in 46; and various disconnective procedures – in 34 patients. Almost routinely employed intraoperative ECOG (134 surgeries) was combined with stimulation and/or SSEP in 47 cases to map eloquent cortex (with CST-tracking in some). A new permanent and not anticipated neurological deficit developed post-surgery in 5 cases (2,5%). Patients were follow-upped using video-EEG and MRI and FU which lasts more than 2 years (median – 3 years) is known in 56 cases. Thirty-two children were free of seizures at the last check (57,2% rate of Engel IA). A list of variables regarding patients’ demography, seizure type, lesion pathology and localization, and those related to surgery and its extent were evaluated to figure out anyone associated with favorable outcome. Both Type II FCDs and their anatomically complete excision are positive predictors for favorable outcome and achievement of SF-status (p<0,05). Residual epileptic activity on immediate post-resection ECOG do not affect the outcome. Patients with Type II FCD, particularly with Type IIb malformations are the best candidates for curative surgery, including cases with lesions in brain eloquent areas. Kids with Type I FCD have much less chances to become free of seizures when attempting focal cortectomy. However, some of them with early onset catastrophic epilepsies may benefit from larger surgeries using lobectomy or various disconnections.

Surgical treatment of epilepsy in children with gloneuronal brain tumors: morphology, MRI semiology and factors affecting the outcome

Glioneuronal tumors (GNT) are usually found in children (less than 1.5% of all neoplasms of the brain). With rare exceptions, they are benign and usually manifest only by epilepsy, which is quite often resistant to treatment with AE drugs. Tumor removal usually helps to cope with epileptic seizures, however, a number of issues regarding diagnosis and surgical treatment (interpretation of morphological data and classification, epileptogenesis and topography of the epileptogenic zone, the value of intraoperative invasive EEG and the optimal volume of resection) remain debatable. To describe the morphology, electro-clinical picture and MR-semiology in patients with gloneuronal brain tumors, as well as to analyse the results of their surgical treatment and the factors determining its outcome. 152 children with a median age of 8 years were treated surgically (There were 64 gangliogliomas, 73 DNT, 15 cases where the tumor classification failed - GNT NOS). In children under 2 years of age, temporal localization of the tumor prevailed. In 81 cases, ECoG was used during the operation. Surgical treatment complications: transient neurological deficit (in 15 cases); hematomas removed without consequences (in 2 cases), infectious (osteomyelitis of bone bone flap in 2 cases). We analyzed: the age of the epilepsy onset (median - 4 years 7 months) and its duration (median - 23.5 months), the type of seizures, as well as the features of MR-semiology and morphology of tumors and adjacent areas of the brain. The volume of tumor resection was verified by MRI (in 101 cases) and CT (in each case). The follow-up was collected through face-to-face meetings, with repeated video EEG and MRI, as well as telephone interviews. We studied the effect of a number of parameters characterizing the patient and features of his/her operation on the outcome of treatmen. Among 102 patients in whom the follow-up history is one year or more (median - 2 years), a favorable outcome (Engel IA) was observed in 86 of them (84%); 55 of them (54%) at the time of the last examination stopped drug AE treatment. Radical tumor removal and younger age at the time of surgery were statistically significantly associated with a favorable result. In children with gloneuronal brain tumors, removal of the tumor is effective and relatively safe in the treatment of symptomatic epilepsy. Radical tumor resection and earlier intervention are the most important prerequisites for a favorable outcome and persistent remission of seizures.

Experience of using reamberin on the cognitive functions in children with epilepsy

To study the efficacy of reamberin in treatment of epilepsy in children and to evaluate its effect on the cognitive functions. The study included 51 patients with epilepsy aged 7 to 15 years. The children were divided into four groups depending on the prescribed treatment. The first study group (n=16) received intravenous reamberin once daily for 5 days in addition to carbamazepine. The second group (n=15) received intravenous reamberin once daily for 5 days in addition to valproic acid. Two comparison groups (10 patients each) received only carbamazepine or only valproic acid, respectively. Cognitive functions were assessed at admission and on the 6th day of treatment using Schulte tables (10 words). Reamberin significantly increases the work efficiency by 19-21%, and workability degree by 8-12% compared with the patients of the control groups. An analysis of the effect of succinate-containing drug on auditory memory has shown that the volumes of short-term memory and long-term memory are by 1.8 times and 1.3 times, respectively, higher than those in the control groups. Thus, the addition of reamberin into the treatment of children with epilepsy should be considered clinically reasonable, and promising.

Effect of efficiency in treatment social and psychological factors life in children with epilepsy (cohort retrospective study)

An important task of modern pediatric neurology is to increase the effectiveness of treatment of epilepsy in children. Traditional criteria for assessing the effectiveness of treatment, based on the indicators of laboratory and instrumental studies, reflect only the biological component of the picture of the disease and it is necessary to apply a criterion for assessing the state of other basic functions of the child.The purpose. To identify the most significant social and psychological problems and aspects of the lives of children and adolescents with epilepsy, depending on the effectiveness of treatment (children with controlled and uncontrolled attacks) from the point of view of patients, their parents and health care professionals, and raising awareness of the sub- the issues related to this state to improve the quality of care for this group of patients to lead a better life.Materials and methods. Surveys on social, psycho-emotional factors of life of children with epilepsy with controlled and uncontrolled attacks were conducted during 1 year with the help of questionnaires for 3 groups of respondents: children and adolescents from 12 to 18 years old, patients with epilepsy, their parents and the medical staff who are in contact with children with epilepsy in their work, the statistical processing of the received data is carried out.Results. The study showed the main factors influencing the lives of children with epilepsy from the point of view of patients themselves, their parents and health professionals. These are social (the opportunity to attend school, communicate with peers, get education and employment in the future) and psycho-emotional (fear of their illness, its concealment from others, difficulty in learning) factors.Conclusions. Most children with uncontrolled attacks receive home-schooling, miss 25.37±2.17 days of schooling, have problems communicating with new people, friends, less self-confident. More than a third of the respondents were informed about problems with memory, concentration and difficulties with math. A common problem for children with epilepsy and their parents is the fear of the future: the opportunity to get education and employment. Parents are concerned about further independent life. For children with uncontrolled attacks, their parents and health workers, the top priority is the effectiveness of treatment - overcoming attacks and the ability to lead an active social life. The complication between patients, their parents and doctors is higher in a group of children with controlled attacks

P.043 Cannabis treatment in children with epilepsy: practices and attitudes of neurologists in Canada

Background: Cannabis has been shown to be an effective therapy for epilepsy in children with Dravet and Lennox-Gastaut syndrome. Despite the fact that many pediatric epilepsy patients across Canada are currently being treated with cannabis, little is known about pediatric neurologists’ attitudes towards it. Methods: A 26-item online survey was distributed to 148 pediatric neurologists across Canada. Results: 56/148 neurologists responded and reported that over 600 children with epilepsy are currently taking cannabinoids. 34% of neurologists authorized cannabis to children, 38% referred children for authorization, and 29% did not authorize or refer their patients. Of those neurologists who referred, 76% referred to a community-based non-neurologist. The majority of physicians authorized cannabis to patients with Dravet syndrome (68%) and Lennox-Gastaut syndrome (64%). Cannabis was never authorized as a first-line treatment. 54% of neurologists stated that their patients were taking CBD alone, despite this option not being available in Canada. All physicians reported having at least one hesitation regarding cannabis, the most common ones being poor evidence (66%), poor quality control (52%), and cost (50%). Conclusions: The majority of Canadian pediatric neurologists use cannabis as a treatment for epilepsy in children. However, there appear to be knowledge gaps and hesitations.

Antiepileptic Drug Treatment of Epilepsy in Children.

The treatment of epilepsy in children is highly individualized at each and every major step in the management. This review examines various factors that modify the treatment from the point of initiation of therapy to the decision to stop an antiepileptic drug (AED). AED therapy leads to seizure freedom in about 70% of all children with epilepsy. AED initiation could be delayed until a second seizure in most children and may be avoided altogether in many children with self-limited childhood focal epilepsies. Three key factors influence the choice of AED: seizure type(s), efficacy of the drug for the seizure type, and the side effect profile of the drug(s). For epileptic spasms, steroids and vigabatrin are the most effective treatment options. For absence seizures, ethosuximide and valproic acid are superior to lamotrigine. For focal seizures, many newer AEDs have favorable side effect profiles with efficacy comparable to older-generation drugs. For generalized epilepsies, valproic acid remains the most effective drug for a broad range of seizure types. Genetic and metabolic etiologies may guide unique treatment choices in some children. After 2 years or more of seizure freedom, if the recurrence risk after AED withdrawal is acceptable, slow weaning of AEDs should be done over the span of 6 weeks or longer. After discontinuation, about 70% of patients remain seizure free, and of those with recurrence, the majority achieve seizure control with restarting an AED. When treatment with two or more AEDs fails, other treatment opportunities for drug-resistant epilepsy, including epilepsy surgery, vagal nerve stimulation, and dietary therapies should be considered. Carefully selected medical therapy guided by seizure type and AED characteristics is effective in more than two-thirds of children with epilepsy.