In this CME offering from NeuroSeriesLive, Dr. Dennis Dlugos takes viewers through the current best practices for pediatric epilepsy. Using two case studies, Dr. Dlugos discusses diagnosis challenges and considerations, goals and concerns of medication treatments, and offers several non-medical treatment options.
Dr. Dlugos, Professor of Neurology and Pediatrics at the Perelman School of Medicine at the University of Pennsylvania introduces the presentation by explaining a quadrant-based matrix that is used for the International Classification of Epilepsies and Epileptic Syndromes. Two main components are for patients with ‘normal development and imaging’ and those with ‘developmental and/or imaging abnormalities.’ The first goal in diagnosis and treatment is to determine which quadrant to assign the patient .
Pediatric Epilepsy Treatment Options
Most treatment options for pediatric and adolescent epilepsy involve medication; Dr. Dlugos reviews a summary table of drugs used for focal, focal and general, and syndrome specific seizures. He stresses treatment goals, including minimizing or eliminating medication side-effects. It is important to choose the correct medication for each patient. Medication choice is not always in regards to efficacy, but tolerability must also be taken into consideration.
In adolescent female patients, it is important to take into account the drug-drug interaction with oral contraceptive pills (OCP). Several anti-epileptic drugs reduce the efficacy of OCPs, but there are many alternatives that do not. Dr. Dlugos also highlights issues with “older medications” including phenobarbital, phenytoin, carbamazepine, and valproate. He continues on with a detailed explanation of the advantages of extended release medications and therapeutic ranges.
Other Treatment Options
Although medications are the primary means of treating epilepsy, the video explores three other options: surgery, diet changes, and vagus nerve stimulation. Surgical considerations include localizing the seizure onset zone, the function of the zone, and weighing the risks and benefits of surgery. Dietary change options are a Ketogenic diet, modified Atkins diet, and low glycemic index diet. Some studies show vagus nerve stimulation decreases seizures by 50 percent in 50 percent of patients and does not carry any medication side effects.
For the details of the presentation and to gain greater insight into treatment options for pediatric epilepsy, please view our online CME session “Meeting the Challenge of Pediatric Epilepsy: Best Practice from Early Childhood through Adolescence” at NeuroSeriesLive.
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