Interventions in childhood epilepsy: pharmacotherapy and ketogenic diet

Epilepsy is the most frequent chronic neurological disorder in children and the majority of children with epilepsy is treated with antiepileptic drugs. Despite the development and availability of more than thirty antiepileptic drugs by now, evidence for their efficacy and tolerability in children with epilepsy is generally limited. However, our studies have shown that the use of newer antiepileptic drugs in the children is still increasing, despite limited evidence and lacking formal registration. More research is therefore needed, but due to logistic, regulatory, legal and ethical issues this remains challenging, as we have experienced ourselves with a randomized controlled trial that had to be stopped prematurely. Changes in the legislation for registration of new antiepileptic drugs for children and international collaborating networks will hopefully lead to more evidence based pharmacotherapy. Furthermore, precision medicine, a personal treatment based on individual characteristics, may become the keystone in the treatment of children with epilepsy. Better insight in the mechanisms of other treatment modalities as cannabidiol, ketogenic diet and neurostimulation, together with advancements in epilepsy surgery, will hopefully lead to broader applicability of all these modalities for children with epilepsy. Introducing ketogenic diet as an all-liquid formulation in an outpatient setting is one of the alternatives we investigated to make ketogenic diet more accessible for some patients/parents. Ketogenic diet can also be considered in children with very rare diseases with comorbid epilepsy, like North See Progressive Myoclonus Epilepsy