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How to combat infantile epilepsies

A recent review highlighted potential methods of managing infantile epilepsies, including levetiracetam, ketogenic diet, modified Atkins diet, and surgery.

Levetiracetam, ketogenic diet, modified Atkins diet, and surgery are effective measures against epilepsy in some infants, according to a recent review.

Children aged 1 to 36 months old experience adverse outcomes from seizures including developmental, behavioral, and psychological consequences. To analyze the effectiveness of surgical, pharmacologic, neuromodulation, dietary, and gene therapy for infantile epilepsies, investigators conducted a review.

Data was gathered from studies published from January 1, 1999, to August 19, 2021. Studies were found through searches using Embase, MEDLINE, PubMed, the Cochrane Library, and gray literature.

Texts on pediatric epilepsy were analyzed for data on individuals aged 1 to 36 months, with key information extracted from included studies. Risk of bias and strength of evidence were rated, and studies and outcomes were summarized narratively.

There were 41 studies included in the review. Data on the strength of evidence (SOE) of different forms of treatment was recorded.

Levetiracetam was observed as a method of seizure freedom in some patients with low SOE, while other pharmacotherapies such as topiramate, lamotrigine, phenytoin, vigabatrin, rufinamide, and stiripentol, did not have conclusive evidence.

Modified Atkins diet and ketogenic diet were observed to cause seizure freedom in some patients with low SOE, and Atkins diet was seen as more effective in reducing number of seizures. Seizure freedom may also be achieved with hemispherectomy and non-hemispheric surgical procedures with low SOE.

Levetiracetam, topiramate, and lamotrigine had observed effectiveness with low SOE, and adverse outcomes from these medications were rarely severe enough to make discontinuation necessary. Loss of appetite and upper respiratory tract infection were observed adverse effects in topiramate with moderate SOE.

Hemispherectomy and nonhemispheric surgical procedures rarely led to surgical mortality, but there was little evidence on mortality or morbidity risk overall.

These results showed a variety of treatment options for infantile epilepsies. As these methods had low SOEs, investigators recommended further research on their effectiveness and long-term outcomes.

Reference

Management of infantile epilepsies. Agency for Healthcare Research and Quality. October 25, 2022. Accessed October 27, 2022. https://effectivehealthcare.ahrq.gov/products/management-infantile-epilepsy/research