Treatment Of Pediatric Epilepsy Research Articles

Identification of miRNAs in extracellular vesicles as potential diagnostic markers for pediatric epilepsy and drug-resistant epilepsy via bioinformatics analysis.

Pediatric epilepsy (PE) is a common neurological disease. However, many challenges regarding the clinical diagnosis and treatment of PE and drug-resistant epilepsy (DRE) remain unsettled. Our study aimed to identify potential miRNA biomarkers in children with epilepsy and drug-resistant epilepsy by scrutinizing differential miRNA expression profiles. In this study, miRNA expression profiles in plasma extracellular vesicles (EV) of normal controls, children with drug-effective epilepsy (DEE), and children with DRE were obtained. In addition, differential analysis, transcription factor (TF) enrichment analysis, Gene ontology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses, and target gene prediction were used to identify specifically expressed miRNAs and their potential mechanisms of action. Potential diagnostic markers for DRE were identified using machine learning algorithms, and their diagnostic efficiency was assessed by the receiver operating characteristic curve (ROC). The hsa-miR-1307-3p, hsa-miR-196a-5p, hsa-miR-199a-3p, and hsa-miR-21-5p were identified as diagnostic markers for PE, with values of area under curve (AUC) 0.780, 0.840, 0.832, and 0.816, respectively. In addition, the logistic regression model incorporating these four miRNAs had an AUC value of 0.940, and its target gene enrichment analysis highlighted that these miRNAs were primarily enriched in the PI3K-Akt, MAPK signaling pathways, and cell cycle. Furthermore, hsa-miR-99a-5p, hsa-miR-532-5p, hsa-miR-181d-5p, and hsa-miR-181a-5p showed good performance in differentiating children with DRE from those with DEE, with AUC values of 0.737 (0.534-0.940), 0.737 (0.523-0.952), 0.788 (0.592-0.985), and 0.788 (0.603-0.974), respectively. This study characterized the expression profile of miRNAs in plasma EVs of children with epilepsy and identified miRNAs that can be used for the diagnosis of DRE.

Disconnection Surgery in Pediatric Epilepsy: A Single Center's Experience With 185 Cases.

Lobar and multilobar disconnections have gradually become common surgical methods in pediatric epilepsy surgery in recent years. However, the surgical procedures, postoperative epilepsy outcomes, and complications reported by each center are quite different. To review and analyze the clinical data from lobar disconnection in treating intractable pediatric epilepsy and study the characteristics, surgical outcomes, and safety of different disconnection surgeries. This was a retrospective analysis of 185 children with intractable epilepsy who underwent various lobar disconnections at the Pediatric Epilepsy Center, Peking University First Hospital. Clinical information was grouped according to their characteristics. The differences in the abovementioned characteristics among the different lobar disconnections were summarized, and risk factors affecting the surgical outcome and postsurgical complications were explored. Among the 185 patients, 149 patients (80.5%) achieved seizure freedom with a follow-up of 2.1 years. There were 145 patients (78.4%) with malformations of cortical development (MCD). The seizure onset time (median 6 months, P = .001) and surgery time (median 34 months, P = .000) of the MCD group were smaller. Differences were found in etiology, resection of the insular lobe and epilepsy outcome among different disconnection approaches. Both parieto-occipital disconnection ( P = .038, odds ratio = 8.126) and MRI abnormalities larger than the disconnection extent ( P = .030, odds ratio = 2.670) affected the epilepsy outcome. Early postoperative complications were observed in 43 patients (23.3%), and long-term postoperative complications were observed in 5 patients (2.7%). The most common etiology of epilepsy in children undergoing lobar disconnection is MCD, whose onset and operative ages are the youngest. Disconnection surgery obtained good seizure outcomes in the treatment of pediatric epilepsy with a low incidence of long-term complications. With advances in presurgical evaluation, disconnection surgery will play a more important role in young children with intractable epilepsy.

Efficacy and safety of lacosamide in the treatment of pediatric epilepsy

Efficacy and safety of lacosamide in the treatment of pediatric epilepsy

0853 The role of sleep-disordered breathing in the optimization of pediatric epilepsy management

Abstract Introduction There is a known bidirectional relationship between epilepsy severity and disordered sleep; however, both the potential scoring limitations of polysomnograms (PSGs) of children with epilepsy and the effect of treatment of sleep disordered breathing (SDB) on epilepsy severity in these children remain poorly understood. Report of Cases: We describe a 7-year-old male with a history of prematurity (ex-34 weeks), bronchopulmonary dysplasia, recurrent aspiration pneumonia, and refractory nocturnal epilepsy who experienced acute hypoxemic respiratory failure in the setting of co-infection with rhinoenterovirus and parainfluenza 4 virus. The patient’s epilepsy history is notable for multiple nocturnal seizures most days of the week for a period of several years. His mother endorsed that the nocturnal seizures began shortly after his SDB symptoms, and that the severity of his nocturnal seizures seemed to be associated with the quality of his sleep. Two years prior to admission, he underwent adenotonsillectomy for mild obstructive sleep apnea (AHI 2.5, REM AHI 8.9, minimum SpO2 86%). He continued to have persistent SDB symptoms (e.g. witnessed apneas, nocturnal arousals 5-10 times/night, daytime sleepiness) despite adenotonsillectomy. Notably, the background EEG (in the context of epilepsy) demonstrated obscured sleep architecture and led to unreliable staging of sleep states and cortical arousals. Given the disorganized background EEG, arousal-based hypopneas could have been underestimated. In the setting of acute respiratory failure, our patient was hospitalized and treated with noninvasive ventilation for 6 days. Collateral benefits included improvements in SDB (evidenced by decreased nocturnal awakenings, lack of obstructive features) and reduction in seizure frequency. His mother noted that this hospitalization was the first time in years that her son did not experience nocturnal seizures. Conclusion Sleep apnea can be an important modifiable factor in the treatment of pediatric epilepsy. Some PSGs of children with epilepsy may be falsely reassuring given the potential difficulty with scoring cortical arousal-based hypopneas. Therefore, careful clinical correlation should be made between nocturnal seizures and sleep symptoms, even in the context of reassuring PSG parameters. Support (If Any) Cystic Fibrosis Foundation Training Grant, AIRE grant, NIH 2T32HL110952-06

Efficacy of a telemedicine programme in the treatment of paediatric epilepsy

IntroductionTelemedicine is a real-time interactive communication method where patients are assessed and treated remotely. Epilepsy is one of the most frequent neurological disorders in childhood. However, specialists and subspecialists are scarce in rural settings. In neurology, telemedicine has been shown to be useful in the treatment of epilepsy and other neurodevelopmental disorders. MethodsWe gathered data from patients diagnosed with epilepsy and managed through telemedicine consultations from January 2011 to February 2020. We collected data on the number of consultations, town/city of origin, treatment, aetiology, seizure type, treatment adherence, loss to follow up, discharges, and comorbidities. ResultsWe identified a total of 467 patients (180 girls and 287 boys). The largest age group was pre-school children, with 160 cases (34.2%). Seizures were focal in 253 cases (54.2%) and generalised in 214 (45.8%). Seizure aetiology was unknown in the majority of patients (69.3%). Ninety percent of patients presented good treatment adherence, and 76.8% were seizure-free. Regarding treatment, 351 patients (75%) were receiving monotherapy, and the most frequently prescribed drug was magnesium valproate, in 225 patients (64.2%). A total of 158 patients (33.8%) presented 1 comorbidity, and 19 (4%) presented 2 comorbidities. ConclusionsIn our study, telemedicine proved to be effective in the treatment and follow-up of paediatric patients with epilepsy living in rural settings. Its usefulness in other neuropaediatric disorders should also be evaluated.

Significant treatment gap and co-morbidities identified in an epidemiological survey of pediatric epilepsy in rural suburbs of India

PurposeA cross-sectional epidemiological survey of children was conducted in two rural clusters to estimate the point prevalence and study various aspects of childhood epilepsy. Material and methodsIn the first stage, a house-to-house survey was conducted by health workers using a screening questionnaire, which was pre-validated in a pilot study. All screen positive houses were visited by pediatric neurologist for detailed evaluation. Children with a clinical diagnosis of epilepsy underwent EEG and were evaluated for type of seizure, epilepsy syndrome, etiology, co-morbidities and treatment gap. Knowledge, attitude and practice regarding epilepsy was assessed amongst caregivers of the affected children. ResultsA total population of 75,455 population was screened, 19,181 children aged 2 months to 18 years were identified. Out of 355 screen positive children, 66 were diagnosed with epilepsy. The point prevalence of pediatric epilepsy was 3.44 per 1000 children. 53% had focal epilepsy, 31.8% had an identifiable epilepsy syndrome, 44% had at least one comorbidity. The etiology was identified in 68%, the commonest being perinatal brain insult. The magnitude of treatment gap was 45.45%, with significant deficits in knowledge. ConclusionThere are significant deficits in diagnosis and treatment of pediatric epilepsy among the rural population of India. The existing rural health care facilities need to be augmented to facilitate the timely diagnosis and optimum care of these children, including care of associated co-morbidities.

Comparison of the Therapeutic Effects of Sodium Valproate and Levetiracetam on Pediatric Epilepsy and the Effects of Nerve Growth Factor and γ-Aminobutyric Acid.

Background:We aimed to investigate the therapeutic effect of sodium valproate combined with levetiracetam on pediatric epilepsy and the effects of nerve growth factor and γ-aminobutyric acid.Methods:Eighty-three epileptic children admitted to Xuzhou Municipal Hospital of Xuzhou Medical University (Xuzhou, China) from Jan 2018 to Nov 2019 were collected and divided into a control group (40 cases, treated with sodium valproate alone) and an observation group (43 cases, treated with sodium valproate combined with levetiracetam). The therapeutic effect and incidence of adverse reactions were observed. The levels of nerve growth factor (NGF), γ-aminobutyric acid (GABA) and serum neuron-specific enolase (NSE) of children were compared. Changes of cognitive function and the total effective rate were evaluated. Logistic regression analysis was used to analyze the risk factors affecting the therapeutic effect.Results:After treatment, NGF, GABA and NSE in the observation group were significantly improved compared with those before treatment. The cognitive function of the observation group was significantly improved after treatment when compared with the control group. The total effective rate in the observation group was higher than that in the control group. Adverse reactions in the observation group were less than those in the control group. Seizure type, NGF, GABA, NSE and treatment methods were independent risk factors affecting the therapeutic effect of pediatric epilepsy.Conclusion:The application of sodium valproate combined with levetiracetam in the treatment of pediatric epilepsy is helpful to improve the overall therapeutic effect, significantly improve the cognitive function of children, and improve the levels of NGF, GABA and NSE.

An Initial Cost-Effectiveness Analysis of Magnetic Resonance-Guided Laser Interstitial Thermal Therapy in Pediatric Epilepsy Surgery

Introduction: Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) is a new technology that provides a clinically efficacious and minimally invasive alternative to conventional microsurgical resection. However, little data exist on how costs compare to traditional open surgery. The goal of this paper is to investigate the cost-effectiveness of MRgLITT in the treatment of pediatric epilepsy. Methods: We retrospectively analyzed the medical records of pediatric patients who underwent MRgLITT via the Visualase® thermal therapy system (Medtronic, Inc., Minneapolis, MN, USA) between December 2013 and September 2017. Direct costs associated with preoperative, operative, and follow-up care were extracted. Benefit was calculated in quality-adjusted life years (QALYs), and the cost-effectiveness was derived from the discounted total direct costs over QALY. Sensitivity analysis on 4 variables was utilized to assess the validity of our results. Results: Twelve consecutive pediatric patients with medically refractory epilepsy underwent MRgLITT procedures. At the last postoperative follow-up, 8 patients were seizure free (Engel I, 66.7%), 2 demonstrated significant improvement (Engel II, 16.7%), and 2 patients showed worthwhile improvement (Engel III, 16.7%). The average cumulative discounted QALY was 2.11 over the lifetime of a patient. Adjusting for inflation, MRgLITT procedures had a cost-effectiveness of USD 22,211 per QALY. Our sensitivity analysis of cost variables is robust and supports the procedure to be cost-­effective. Conclusion: Our data suggests that MRgLITT may be a cost-effective alternative to traditional surgical resection in pediatric epilepsy surgery.

Sodium valproate combined with levetiracetam in pediatric epilepsy and its influence on NSE, IL-6, hs-CRP and electroencephalogram improvement.

Efficacy of sodium valproate combined with levetiracetam (LEV) in pediatric epilepsy and its influence on neuron-specific enolase (NSE), interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hs-CRP) as well as electroencephalogram (EEG) improvement were studied. Patients (n=100) with pediatric epilepsy admitted to and treated in Xiantao First People's Hospital Affiliated to Yangtze University from December 2015 to 2018 were enrolled in this study and randomly divided into observation group (n=50) and control group (n=50). Sodium valproate was administered in the control group, and the treatment with LEV was combined with sodium valproate in the observation group. After 12 weeks the cognitive function of patients was assessed using the Mini-Mental State Examination (MMSE) scale, Montreal cognitive assessment (MoCA) scale and Wechsler Memory Scale-Revised in China (WMS-RC). The quality of life (QOL) of patients was evaluated with the QOL in epilepsy-31 inventory (QOLIE-31) scale and Barthel Index, and blood was drawn from the patients to detect the neurological function indicators [NSE and glial fibrillary acidic protein (GFAP)] and inflammatory indicators (IL-6, IL-2 and hs-CRP). After treatment, the incidence rates of adverse reactions notably declined in the observation group (P<0.05), and the improvement in the cognitive function in the observation group were both superior to those in the control group (P<0.05). Observation group had lowered content of NSE, GFAP, IL-6, hs-CRP and IL-2 (P<0.05), and α wave was markedly decreased, but θ and δ waves were notably increased in the observation group (P<0.05). In the treatment of pediatric epilepsy, sodium valproate combined with LEV produces better efficacy, fewer adverse reactions, significantly improves patients' QOL and notably lowers the content of NSE, IL-6 and hs-CRP with notable EEG improvement, so it is a safe and reliable treatment that is worth popularization.

Effect of Mozart K.448 on interictal epileptiform discharges in children with epilepsy: A randomized controlled pilot study

BackgroundEpilepsy is a common pediatric neurologic disease in Thailand. However, the mainstay antiepileptic pharmacotherapies can induce severe side effects. While the benefit of playing Mozart K.448 music has been studied as an alternative, supplementary, nonpharmacologic treatment for epilepsy, the literature features limited few randomized controlled trial studies of children. ObjectiveWe aimed to study the effect of Mozart K.448 for two pianos on interictal epileptiform discharges (IEDs), quantitative electroencephalogram (qEEG), and heart rate variability (HRV) in patients with epilepsy. MethodsWe employed a single-blinded randomized trial design with a placebo control. The treatment group listened to the first 8 min of Mozart K.448 for two pianos during EEG recording. The control group underwent an EEG recording of the same duration in a quiet environment. Interictal epileptiform discharges were manually counted for 8 min before, during, and after the song was plated. Quantitative electroencephalogram and HRV were analyzed in each period. ResultA total of 32 patients aged 0–18 years were enrolled. There were 12 patients in the music group and 14 patients in the control group; 67% of the patients in the former exhibited significantly decreased IEDs while listening to the music compared with 42% of the patients in the quiet group (RR [Relative Risk Reduction]: 0.72, p-value: <0.001, 95% confidence interval [CI]: 0.69–0.74). During music exposure, qEEG demonstrated an increase in the delta/theta to alpha/beta ratio relative to that of controls (median in music: +3% and control: −6%, p-value: 0.520). Heart rate variability analyses showed a decrease in the ratio of low frequency to high frequency (LF/HF), which represents parasympathetic activity during music exposure (decrease of 34%, p-value: 0.382). ConclusionThe present study showed that Mozart K.448 reduced the number of IEDs in children with epilepsy and that Mozart K.448 could enhance parasympathetic activity. However, possibly because of the small study population, statistical significance was not reached. Our study revealed the considerable potential of music in the treatment of pediatric epilepsy.

Comparative analysis of zonisamide and topiramate use in treatment of pediatric epilepsy in real clinical practice: the results of a retrospective study and related clinical cases

Background. Comparative study of antiepileptic drugs allows to make the optimal choice in therapy.The aim of the study: a comparative analysis of the administration of two similar by chemical structure antiepileptic drugs (zonisamide and topiramate) in the outpatient practice in epilepsy in children, taking into account the efficacy and tolerability.Materials and methods. A retrospective analysis of outpatient charts of equal in number (n = 18) groups of patients with different forms of epilepsy treated with zonisamide and topiramate in monotherapy and in combined therapy was carried out.Results. In general, no statistically significant difference in the efficacy of zonisamide and topiramate was obtained (p = 0.692). Efficacy in structural focal epilepsy was also comparable (absence of seizures 54.6 % and 45.5 %, respectively). With comparable efficacy, zonisamide was administered to patients much later in the antiepileptic drugs (Me = 5) than topiramate (Me = 3). Side effects on zonisamide were registered in 27.8 %, side effects on topiramate – in 38.9 % (p = 0.480). The difference in the effect of these drugs on cognitive functions was noted.Conclusions. Zonisamide shows its effectiveness in different forms of epilepsy in children, despite the later appointment in practice. The drug is well tolerated and probably has less negative effect on children’s cognitive functions than topiramate.

The Effectiveness of Medical and Surgical Treatment for Children With Refractory Epilepsy

Abstract INTRODUCTION Pediatric refractory epilepsy affects quality of life, clinical disability, and healthcare costs for patients and families. We aimed to show the impact of surgical treatment for pediatric epilepsy on healthcare utilization compared to medically treated pediatric epilepsy over 5 yr. METHODS The Pediatric Health Information System database was used to study hospitalized children with epilepsy using five published algorithms. Refractory epilepsy (RE) patients treated with either antiepileptic medications (AEDs) only or AEDs plus epilepsy surgery (ES) between 1/1/2008 and 12/31/2014 were included. Patients with a history of ES before 1/1/2008 or a vagus nerve stimulation implantation surgery were excluded. ICD-9-CM codes were used to identify ES. Healthcare utilization following the index date at 2- and 5-yr including inpatient, emergency department (ED), and all epilepsy-related visits were evaluated. The propensity scores (PS) method was used to match surgically and medically treated patients. Covariates associated with the probability of receiving surgical treatment were chosen in the logistic regression model for calculating PS. SAS 9.4 and Stata 14.0 were used for data management and statistical analysis. RESULTS A total of 2106 (17.1%) and 10186 (82.9%) were surgically and medically treated, respectively. A total of 4050 matched cases, 2025 per each treated group, were included. Overall survival rates of matched cases were 98.07% and 99.58% at 2-yr and 96.66% and 98.99% at 5-yr for medically and surgically treated patients, respectively. Within 5-yr follow-up, seizure-associated healthcare utilization was lower for the surgically treated group: number of inpatient visits were 3.9 vs 2.5 and ED visits were 3.2 vs 1.7 for medically and surgically treated patients, respectively. The number of AEDs at 1-yr follow-up was significantly lower for the surgically treated group (3.22 decreased to 2.59: surgical group, 3.24 decreased to 3.06: medical group). CONCLUSION We found a significant decrease in inpatient and ED visits and number of antiepileptic drug prescriptions, as well as higher survival rates, at 2- and 5-yr follow-up in the surgically treated group compared to the medically treated group for pediatric patients with refractory epilepsy. Pediatric epilepsy surgery can provide beneficial outcomes, favorable long-term effectiveness, and reduced healthcare utilization compared to medical management.

Exploring the Rationale for the Use of the Ketogenic Diet in the Treatment of Mental Health Disorders

(1) Background: The ketogenic diet (KD) was developed in the 1920s as a treatment for pediatric epilepsy and is emerging as a possible treatment option for certain mental health disorders. There is a link between certain mental health disorders and epilepsy, suggesting some commonality among underlying mechanisms. (2) Methods: The literature relating to mental disorders and the KD is sparse. The authors attempt to a narrative review of the existing literature to show that there may be validity to studying the KD as a treatment for certain mental health disorders. (3) Results: Various types of mitochondrial dysfunction and impaired oxidative metabolism have been identified in many mental health disorders (bipolar disorder, major depressive disorder, autism, schizophrenia, and others). Mitochondrial deficits may affect neuroplasticity and cause synaptic dysfunction, which could change brain structure and function in a way that might affect behavior. The KD has been associated with epigenetic changes in the genes associated with mitochondrial function. Chronic oxidative stress and inflammation have also been implicated in mental health disorders and may be reduced by the KD. The KD regulates glutamatergic transmission and may initiate extracellular changes as well, in a manner similar to pharmacological agents used to stabilize moods. The KD may be difficult for patient adherence and has been associated with many and potentially severe adverse effects. The role of the KD in addressing treatment-resistant pediatric epilepsy is established and epilepsy is comorbid with a number of mental health conditions. (4) Conclusions: There is a paucity of literature on this subject and there is no robust clinical evidence in support of the use of the KD for treating mental disorders but there are indications that the KD can reduce systemic inflammation, improve cerebral mitochondrial metabolism, and enhance endogenous antioxidation, all of which may be helpful in treating certain mental health conditions. The KD is also associated with serious health risks and clinicians must weigh risks versus benefits.

Common Errors in Diagnosis and Treatment of Pediatric Epilepsy

Background: epilepsy affects people in all nations and of all races. Its incidence is greater in African American and socially disadvantaged populations. Epilepsy is the most commonly encountered neurologic conditions in children. Aim of the Work: learning from one's mistakes is the best learning tool in medicine and this applies as well to epilepsy, so the aim of our work is to review some of the most frequently identified mistakes and errors in the diagnosis and treatment of pediatric epilepsy and how to avoid their occurrence. Patients and Methods: the study included fifty children with epilepsy and condition mimic epilepsy, aged less than fifteen years (35 males and 15 females). The children participating in the present study were selected randomly from patients attending the pediatric neurology outpatient clinic of Al-Azhar University Hospital. The present work was conducted from January 2018 till the end of September 2018. Results: in the present study it was found that 70 % of the studied patients are males and 30 % females. 76% of our patients were coming from rural areas, and only 24% living in urban. In this study we found that 34 % of our patients are wrongly diagnosed as Epilepsy. The study showed that 27% of epileptic cases are not controlled mostly due to improper selection of drug in 55.6 % and 44.4 % due to improper dose. Conclusion: In fact, in patients with epilepsy, a detailed history is likely to lead to an accurate diagnosis in up to 90% of patients

Common Errors in Diagnosis and Treatment of Pediatric Epilepsy

Common Errors in Diagnosis and Treatment of Pediatric Epilepsy

Cannabis for pediatric epilepsy: protocol for a living systematic review

BackgroundPediatric epilepsy, including treatment-resistant forms, has a major effect on the quality of life, morbidity, and mortality of affected children. Interest has been growing in the use of medical cannabis as a treatment for pediatric epilepsy, yet there has been no comprehensive review of the benefits and harms of cannabis use in this population. In this systematic review, we will search for, synthesize, and assess the published and gray literature in order to provide usable and relevant information to parents, clinicians, and policy makers.MethodsWe will perform a living systematic review of studies involving the use of cannabis to treat pediatric epilepsy. We will search the published and gray literature for studies involving children with any type of epilepsy taking any form of cannabis. Studies will be selected for inclusion by two independent reviewers. The primary outcome is seizure freedom. Secondary outcomes are seizure frequency, quality of life (child, caregiver), quality and quantity of sleep, status epilepticus, tonic-clonic seizures, death (all-cause, sudden unexpected death in epilepsy), gastrointestinal adverse events (diarrhea, vomiting), and visits to the emergency room. The quality of each included study will be assessed. If data are sufficient in quantity and sufficiently similar, we will conduct pairwise random-effects meta-analysis. We will repeat the literature search every 6 months to identify studies published after the previous search date. Sequential meta-analysis will be performed as necessary to update the review findings.DiscussionOur review aims to provide a comprehensive and up-to-date summary of the available evidence to inform decisions about the use of cannabis in children with treatment-resistant epilepsy. The results of this review will be of use to parents, clinicians, and policy makers as they navigate this rapidly evolving area.Systematic review registrationPROSPERO CRD42018084755

Adjunctive Eslicarbazepine Acetate in Pediatric Patients with Focal Epilepsy: A Systematic Review and Meta-Analysis.

In the treatment of pediatric epilepsy, there is a critical demand for effective and safe therapeutic options to address patients' unmet clinical needs. Eslicarbazepine acetate is a novel once-daily antiepileptic drug and a third-generation single enantiomer member of the dibenzazepine family. The objective of this study was to evaluate the efficacy and safety of eslicarbazepine acetate as add-on treatment for focal-onset seizures in pediatric patients using meta-analytical techniques. Randomized, placebo-controlled, single- or double-blinded add-on trials of eslicarbazepine acetate in patients < 18years of age with focal-onset seizures uncontrolled by concomitant stable antiepileptic drug regimens were identified through a systematic literature search. The assessed outcomes included the mean relative change and ≥ 50% reduction in the baseline seizure frequency, the incidence of treatment withdrawal, serious adverse events, and treatment-emergent adverse events. Risk ratio and weighted mean difference with 95% confidence intervals were estimated for dichotomous/continuous outcomes. Two trials were included involving 386 participants (age range 2-18years), 217 for eslicarbazepine acetate and 169 for placebo groups, respectively. At the dosage of 30mg/kg/day, eslicarbazepine acetate-treated patients had a significantly greater reduction in baseline seizure frequency (weighted mean difference - 21.67, 95% confidence interval - 40.87 to - 2.46; p = 0.027) and 58 patients (44.6%) were seizure responders compared with 27 controls (29.7%) [risk ratio 1.48, 95% confidence interval 0.99-2.20; p = 0.055]. There were no differences in treatment withdrawal (risk ratio 1.24, 95% confidence interval 0.65-2.37; p = 0.513), serious adverse events (risk ratio 1.40, 95% confidence interval 0.69-2.86; p = 0.350), and treatment-emergent adverse events (risk ratio 1.07, 95% confidence interval 0.94-1.22; p = 0.313). Adjunctive eslicarbazepine acetate could be an effective well-tolerated option in children and adolescents with focal-onset seizures uncontrolled by one or more concomitant anti-epileptic drugs.

Cannabidiol in Pediatric Epilepsy

To summarize current understanding of the role of endocannabinoids as well as exogenous cannabinoids such as tetrahydrocannabiniol and cannabidiol in the functions of the body, including the brain, and to explore the role of cannabidiol in the treatment of pediatric epilepsy. Previously, the evidence supporting the role of cannabidiol in the treatment of epilepsy was largely anecdotal. In 2017, two randomized, placebo-controlled, clinical trials suggested that cannabidiol may be effective in the treatment of epilepsy, though conclusions about both seizure reduction and adverse effects are clouded by the large number of patients taking concomitant anti-seizure medications (such as valproic acid and clobazam) whose serum levels are often increased with the administration of cannabidiol. Cannabidiol has been well-tolerated in pediatric patients and may be an effective treatment for medically intractable epilepsy. Future studies that control for concomitant administration of clobazam and/or valproic acid are necessary.

Hemispherotomy in the treatment of pediatric epilepsy

Hemispherotomy in the treatment of pediatric epilepsy

Perampanel (Fycompa) Use in the Treatment of Pediatric Epilepsy (P5.234)

Perampanel (Fycompa) Use in the Treatment of Pediatric Epilepsy (P5.234)