Treatment of partial XXXX in childhood : an overview.

@entity1 @entity410 @entity2812 @entity227 @entity4677 @entity2682 @entity2051 @entity5305 @entity137 @entity1092 @entity10315 @entity109 @entity302 @entity3174 @entity1771 @entity2807 @entity2049 @entity2810
The treatment of partial @entity410 in @entity1 is based on the use of first generation and recently introduced antiepileptic drugs as well as nonpharmacological treatments such as the ketogenic diet, vagus nerve stimulation and surgical therapy. The present review discusses the efficacy and tolerability of different treatment options for partial @entity410 in childhood. Few adjunctive or monotherapy, placebo-controlled or comparative trials of the first-generation antiepileptic drugs and some of the more recently introduced antiepileptic drugs have been performed in @entity1 . This can be explained by the fact that it is only relatively recently (1989) that the International League against @entity302 proposed that randomised, controlled trials be included among the required criteria for assessing the efficacy and tolerability of an antiepileptic agent. This led to controlled, comparative trials among older antiepileptic drugs ( @entity109 , @entity3174 , @entity2049 and @entity1092 ), both in adults and in paediatric @entity1 , being performed relatively 'late', based on when these drugs were first introduced. @entity2049 and @entity1092 may still be considered as first-line antiepileptic therapies for @entity1 with partial @entity410 . @entity109 and @entity3174 are mostly considered as last choice drugs because of their adverse event profiles. The new generation of antiepileptic agents has added to the first- and second-line treatment options for paediatric partial @entity410 . To date, there are sufficient data to support the clinical use of some of the recently introduced antiepileptic drugs (e.g. @entity2051 , @entity1771 , @entity2682 and @entity2812 ) as adjunctive or first-line monotherapy. Because of the risk of @entity227 with @entity5305 , the use of this drug is currently limited to @entity1 refractory to other medications. @entity2810 , @entity2807 , @entity4677 and @entity10315 have been shown to be effective in adults with partial @entity410 ; however, at present there are not yet enough data on the efficacy of these drugs in @entity1 to support consideration of their use as either first-line or add-on therapy in this @entity1 population, although controlled studies are expected shortly. Furthermore, the use of @entity2807 is considerably limited by rare, but severe, hepatic and haematological @entity137 . Controlled trials for paediatric partial @entity410 are still lacking for the ketogenic diet and vagus nerve stimulation, though they may represent, in given @entity1 , useful adjunctive alternative treatments for refractory partial @entity410 . In conclusion, further trials are needed to determine an optimal sequence of first- and second-line therapies and to establish whether other newer antiepileptic drugs merit consideration as initial therapy in @entity1 with partial @entity410 .
