The challenges and innovations for therapy in children with epilepsy.
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.
Red Cross War Memorial Children's Hospital, University of Cape Town, Rondebosch 7700, South Africa.
Jo M
JM
Wilmshurst
Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Chicago, IL 60611, USA.
Anne T
AT
Berg
Department of Pediatric Neurology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
Lieven
L
Lagae
Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute, PO Box 230, Kilifi 80108, Kenya.
Charles R
CR
Newton
UCL Institute of Child Health, 4/5 Long Yard, London WC1N 3LU, UK.
J Helen
JH
Cross
D000927:Anticonvulsants / Q000627:therapeutic use; D002648:Child; D004569:Electroencephalography; D004827:Epilepsy / Q000175:diagnosis* / Q000453:epidemiology / Q000235:genetics / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D009154:Mutation / Q000235:genetics; D062550:NAV1.1 Voltage-Gated Sodium Channel / Q000235:genetics
D000927:Anticonvulsants; D062550:NAV1.1 Voltage-Gated Sodium Channel; C568242:SCN1A protein, human