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Patient considerations in the management of focal seizures in children and adolescents

Authors Kenney D, Wirrell E

Received 3 January 2014

Accepted for publication 30 January 2014

Published 9 April 2014 Volume 2014:5 Pages 49—65

DOI https://doi.org/10.2147/AHMT.S44316

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Video abstract presented by Daniel Kenney

Views: 760

Daniel Kenney, Elaine Wirrell

Department of Neurology, Mayo Clinic, Rochester, MN, USA

Abstract: Focal epilepsy accounts for approximately one-half to two-thirds of new-onset epilepsy in children. Etiologies are diverse, and range from benign epilepsy syndromes with normal neuroimaging and almost certain remission to focal malformations of cortical development or hippocampal sclerosis with intractable seizures persisting lifelong. Other important etiologies in children include pre-, peri-, or postnatal brain injury, low-grade neoplasms, vascular lesions, and neuroimmunological disorders. Cognitive, behavioral, and psychiatric comorbidities are commonly seen and must be addressed in addition to seizure control. Given the diverse nature of focal epilepsies in children and adolescents, investigations and treatments must be individualized. First-line therapy consists of prophylactic antiepileptic drugs; however, prognosis is poor after failure of two to three drugs for lack of efficacy. Refractory cases should be referred for an epilepsy surgery workup. Dietary treatments and neurostimulation may be considered in refractory cases who are not good candidates for surgery.

Keywords: epilepsy, child, adolescent, treatment, surgery, ketogenic diet, epidemiology

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