Over 60 percent of children with epilepsy will respond to antiepileptic drugs.epilepsy phenotype is the primary determinant of anti-epileptic drug of choice in children. Epilepsy syndromes usually present in childhood and may be associated with refractory seizures. Even though monotherapy is preferred in the treatment of epilepsy because of adverse effects of anti-epileptic drugs, polytherapy may be required in epilepsy syndromes with refractory seizures. Lennox=Gastaut syndrome is an epilepsy syndrome characterised by multiple seizure types and cognitive decline as well as characteristic EEG findings.
The decision whether or not to start AED in children is determined by the natural history of some childhood epilepsies, the risk the child is exposed to if anti-epileptic drug treatment is not started and the risk benefit analysis of anti-epileptic drug treatment and its cognitive effects. For instance children ‘outgrow ‘ childhood focal epilepsies like benign epilepsy with centro-temporal spikes(BECTS) and their seizures are usually focal and nocturnal. They may have no need for initiation of treatment. However those who have daytime seizures, prolonged and/ or generalized tonic-clonic seizure would need to commence antiepileptic drug treatment. The natural history of BECTS which was formerly called Rolandic epilepsy has shown that it resolves at about the age of 13 years hence an individual with BECTS who is over the age of 13 is said to have “outgrown” the disease. Electrical status epilepticus in slow wave sleep (ESES) is another focal childhood epilepsy which a child is expected to outgrow by the age of 8 to 9 years. This type of epilepsy is associated with cognitive dysfunction attributable to the seizures therefore initiating antiepileptic therapy in this group of patients may be more beneficial to improve the cognitive function rather than letting them get to the age where it resolves.