Care of children with epilepsy

Research output: Contribution to journalArticle

Abstract

Treating epilepsy in children is different from treating epilepsy in adults. Unique epilepsy syndromes, drug pharmacokinetics and unique treatments all contribute to the challenges involved in treating children with epilepsy. Even when the same drug is used to treat the same type of seizure, there are differences in drug pharmacokinetics, adverse events, and dosing schedules and formulations. Choosing an effective antiepileptic drug (AED) is further complicated by the fact that the newer AEDs often are tested only in adults, thereby creating an information gap regarding drug treatment for children. Some epilepsy syndromes occur only in children, whereas others persist into adulthood. Some epilepsy syndromes and seizure types are benign and amenable to treatment, whereas others are more serious and often refractory to treatment. Seizure types and presentations vary, as does use of resources. About half of all patients with complex partial seizures, the most common seizure type, have childhood onset. School and behavioral problems are common in children with these seizures, as are accidents, injuries, and stigmatization. Such children should be evaluated by a neuropsychologist who can help devise an educational strategy and behavior modification plan if necessary. Two epilepsies, West syndrome and Lennox-Gastaut syndrome, deserve special attention, not only for their severity and poor outcomes but also for their disproportionate use of resources and profound impact on the quality of life. Although the introduction of newer AEDs offers some hope for better seizure control, experience with these drugs in children is limited, largely because they are not indicated for this age group. As with all drugs, the risks should be weighed against the benefits before initiating treatment with any of these agents. The ketogenic diet is again being considered as a form of epilepsy treatment in children whose seizures are refractory to therapy with AEDs. This medically prescribed diet is initiated in the hospital with a fast to deplete the child's glucose and carbohydrate reserves and induce ketosis in an effort to control the child's seizures. Once the child is ketotic, the high-fat, very-low-carbohydrate, low-protein diet is begun. The diet is designed by a registered dietitian and calculated specifically for the child, based on his or her age, body weight, and activity level. The third option for children with refractory seizures is a surgical procedure. This could include traditional epilepsy surgery on the brain or vagus nerve stimulation. Whatever treatment modality is chosen for the child with epilepsy, it should be directed not only toward seizure control itself but also toward resolving the problems associated with epilepsy.

Original languageEnglish (US)
JournalAmerican Journal of Managed Care
Volume4
Issue number9
StatePublished - 1998
Externally publishedYes

Fingerprint

epilepsy
Child Care
seizure
Epilepsy
Seizures
drug
Pharmaceutical Preparations
Therapeutics
Hope
Pharmacokinetics
Carbohydrates
Ketogenic Diet
Diet
Vagus Nerve Stimulation
Infantile Spasms
behavior modification
Stereotyping
Protein-Restricted Diet
Ketosis
Nutritionists

All Science Journal Classification (ASJC) codes

  • Medicine(all)
  • Nursing(all)
  • Health(social science)
  • Health Professions(all)

Cite this

Care of children with epilepsy. / Wheless, James.

In: American Journal of Managed Care, Vol. 4, No. 9, 1998.

Research output: Contribution to journalArticle

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