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Treatment Options for Children with Epilepsy

Posted Aug 24 2008 1:49pm
ANNOUNCER: You've just heard your child has epilepsy. You're not alone. Each year the parents of 45,000 children under the age of 15 hear that their children have this neurologic condition.

MICHAEL DUCHOWNY, MD: In epilepsy there is a tendency for regions of the brain to electrically discharge all at the same time. When that happens, the manifestations are a seizure, and the manifestations reflect where in the brain the seizure has come from.

ANNOUNCER: Some forms of seizures may disappear as the child gets older.

MICHAEL DUCHOWNY, MD: Small children, usually under the age of three, are prone to a certain type of seizure called febrile seizure, which is a seizure associated with a high fever. It peaks at 18 months and is generally gone by age three.

TREVOR RESNICK, MD: The most common form of partial seizures, meaning seizures involving just a localized area in the brain in children is something called benign rolandic epilepsy. And that's a form of seizure that occurs usually at night, characterized by gagging or drooling. And almost always as the child grows older and into adolescence, the seizures go away.

ANNOUNCER: But there are also childhood seizures, which persist into adulthood.

TREVOR RESNICK, MD: There are various kinds of generalized seizures that are characterized by generalized body stiffening or by just staring blankly ahead or by having staring followed by jerking, followed by stiffening.

There are seizures that are partial. Those seizures are unassociated with a change in consciousness. So for example, a child may be jerking the left arm and be able to say, "What's wrong with me? My left arm is jerking."

Partial complex seizures render the child to have a change in consciousness where they're not entirely with it.

ANNOUNCER: Since epilepsy can appear in different ways, it's often hard to identify. Physicians rely on a variety of information to pinpoint the problem.

TREVOR RESNICK, MD: The history that you get from the family or the patient really is your best clue. And the backbone diagnostic help for the diagnosis of a patient with seizures or epilepsy is an EEG, which is a brainwave test.

ANNOUNCER: Of course eliminating the seizures is on every parent's, and every child's, wish list. For years medication gave some relief but it came at a cost.

TREVOR RESNICK, MD: So you may get an effect on cognition. You may get dizziness. You may get double vision. There may be various other kinds of effects on brain function. The older medications had a greater propensity to have those kinds of side effects, but not always.

ANNOUNCER: These kinds of side effects could be almost as bad as the seizures.

TREVOR RESNICK, MD: Children may either have problems with learning, they may have problems with somnolence, difficulty with sleeping or actually the opposite, and may be hyperactive or irritable or have behavioral problems.

ANNOUNCER: The goal of medical research was to create medications with fewer side effects.

Today, a new generation of drugs are meeting that challenge.

TREVOR RESNICK, MD: They're at least equally effective, but there is a definite superiority with the newer agents with respect to safety and side effects.

The safety profile in terms of an allergic reaction and something bad happening is much less frequent and much less liable to happen with the newer medications. The side effect profile with most, if not all, of the newer agents is much better than the older agents.

ANNOUNCER: Use of a single drug, known as monotherapy, means fewer drug interactions.

TREVOR RESNICK, MD: Everybody agrees that the initial treatment is monotherapy. In other words, one drug to try and control the seizures completely.

MICHAEL DUCHOWNY, MD: There are very few drugs that are approved for monotherapy in children. Trileptal has been approved for monotherapy.

ANNOUNCER: Physicians do their best to control their young patients with monotherapy.

MICHAEL DUCHOWNY, MD: If the child turns out to have resistant epilepsy, where the medications are ineffective, and several monotherapy regimens have been tried, it may be time to think about some type of adjunctive therapy, meaning a combination of more than one medicine to bring the seizures under control. Fortunately, that situation is uncommon.

ANNOUNCER: But for children who don't respond to medication, science has actually discovered a diet that can help. The diet is very restrictive and has its own side effects, but is useful for children with difficult-to-control seizures.

MICHAEL DUCHOWNY, MD: The diet that is used in most centers is called the ketogenic diet. This is a diet which is very high in fats and proteins with virtually no carbohydrates. The diet is effective for all types of seizures in approximately 40 percent of the cases, and there's probably another 10 or 20 percent that get significant benefit.

ANNOUNCER: Surgery may also be an option.

TREVOR RESNICK, MD: If it becomes evident after using one or two medications that the seizures are not controlled and there's an identifiable area in the brain where there's a scar or a tumor or an abnormal region, that patient is a very good candidate for resective surgery, and the outcome is excellent.

ANNOUNCER: No one wants to hear their child has epilepsy, but the outlook today is more positive than ever.

MICHAEL DUCHOWNY, MD: I think the future for children with epilepsy is getting better and better. We have a wide variety of new treatments available. I'm excited about the possibility of genetic therapy and stem cell therapy. All of these, I think, offer tremendous potential for the future.

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