The medical management of the epilepsies in children: conceptual and practical considerations

Summary Epilepsy in children encompasses several syndromes. The cardinal feature of these syndromes is a predisposition to epileptic seizures but each is associated with different prognoses. The goals of treatment will clearly differ between children who become seizure-free on antiepileptic drug (AED) treatment and those children with refractory epilepsy. Treatment should be tailored to the needs of the patient, with a comprehensive approach that addresses the common additional morbidities in children with epilepsy. In this Review, we present an overview of the medical management of epilepsy in children and discuss the dilemmas of everyday practice, such as selection of AED, assessment of outcome, monitoring of treatment, and the decision to withdraw medication when the child is free from seizures. Furthermore, we emphasise the need to establish rational goals for treatment, such as aiming for the best possible quality of life rather than freedom from seizures at all costs.