Updates on Treatment Strategies in Pediatric Epilepsy

Epilepsy is an umbrella term for a common neurological disorder in children, affecting more than ۵ cases in every ۱۰۰۰ of general pediatric population. Intractability or refractoriness in about ۳۰% of the affected population has led to overwhelming growth in the pharmacologic armamentarium as well as non-pharmacologic treatments of epilepsy in the last century and especially in the recent decades.Tremendous progress in basic sciences especially in “genetics” has changed the “treatment paradigms” in pediatric Epileptology from more simple semiological and syndromic approach to targeted approach (i.e. precision medicine) to epilepsy treatment. Nowadays rather than dealing with a single entity such as “Ohtahara syndrome”, we are confronting a wide spectrum of “Early Infantile Epileptic Encephalopathy, EIEEs” with different genetic mutations and a variety of genes involved, each of them seeks different treatments based on the end-point product (protein) of that gene, resulting different functions of that protein. Some of them per se are responsive to sodium channel blockers while others are quite resistant to it. This different new paradigm is the basis for targeted approach to epilepsy treatment in children.On the other hand many recent advances in pediatric epilepsy surgery has improved the outcome and decreased morbidity in comparison to previous conventional methods. Different technics of ablation of the epileptogenic zone such as thermal and ultrasonic ablations have replaced old resective operations.Updates and improvements in ketogenic diet have also changed the practicality and palatability of this treatment method and in addition to reduction in side effects has increased the success rate of this method. Ketogenic diet is also an efficient method and a good alternative to epilepsy surgery in countries with “low income” economies.