Using antiepileptic drugs in children : recent developments and recommendations

Abstract

Epilepsy is one of the most common neurological disorders, with approximately 45 per 100,000 children developing new-onset epilepsy every year. Children are a vulnerable population with unique health needs and a correct diagnosis and thus correct treatment of epilepsy in children, particularly a diagnosis of early onset epilepsy, is important in order to ensure better quality of life, neurodevelopmental outcomes, cognition, education, improved level of function and future employment. Therapy with antiepileptic drugs (AEDs) aims to minimize the frequency of epileptic seizures with minimal side effects. The first generation AEDs (such as phenytoin, carbamazepine and valproic acid) are still widely used, although they are associated with serious side effects and pharmacokinetic problems (narrow therapeutic indices, nonlinear kinetics, and drug-drug interactions due to enzyme inhibition and enzyme induction properties). The novel AEDs (such as lamotrigine, levetiracetam, rufinamide, and zonisamide) have expanded the treatment options of epilepsy, however they are also associated with severe pharmacokinetic shortcomings, especially for paediatric populations. This educational article will discuss how the correct use of these drugs can lead to improved quality of life measures. This paper also provides an overview of ongoing research on the use of population pharmacokinetics in addressing the challenges paediatric populations offer to drug and dose individualisation.