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the myoclonic and absence seizures which characterise these syndromes. Further, when
initiating teenage girls on medication that may need to be lifelong, the possibility of pregnancy
and the effects of AEDs in utero need to be taken into consideration and individuals counselled
accordingly; this is particularly important when discussing and prescribing sodium valproate.

Summary and conclusions

 The choice of AED in treating the childhood epilepsies will be determined by the
epilepsy syndrome (and therefore the specific seizures that help to define the
syndrome), safety profile and, to a slightly lesser extent, its ease of use (formulation
and dosing regimen)

 Sodium valproate appears to remain the most effective AED in treating generalised
seizures

 Lamotrigine, closely followed by carbamazepine or oxcarbazepine, appears to be the
most effective and ‘best tolerated’ AED in treating focal seizures

 The major benefit of the newer AEDs seems to be their lower (and also milder)
incidence of adverse side effects although there are some exceptions

 It is important to be aware of drugs that may exacerbate some seizure types
 The temptation should be strongly resisted to indulge in polypharmacy; it is always

easier to add another drug than to withdraw one. There are no convincing data that the
simultaneous use of three AEDs results in better seizure control than two drugs.
‘Polypharmacy’ increases the risk and incidence of adverse side effects; in addition,
three drugs, in causing drowsiness and disturbing sleep patterns, may paradoxically
cause a deterioration in seizure control, as well as an increase in adverse side effects.
Consequently the prescribing mantra must be ‘if I add, what can I take away’ to avoid
dangerous polypharmacy.

References

1. VERITY, C.M. (1988) When to start anticonvulsant treatment in childhood epilepsy: the case for early treatment.
Br Med J 287, l528-1530.

2. MELLOR, D. (1988) When to start anticonvulsant treatment in childhood epilepsy: the case for avoiding or delaying
treatment. Br Med J 297, 1529-1530.

3. GREENWOOD, R.S. and TENNISON, M.B. (1999) When to start and when to stop anticonvulsant therapy in
children. Arch Neurol 56, 1073- 1077.

4. FISHER, R.S., ACEVEDO, C., ARZIMANOGLOU, A. et al (2014) An operational clinical definition of epilepsy.
Epilepsia 55, 475-482.

5. FARRELL, K. (1986) Benzodiazepines in the treatment of children with epilepsy. Epilepsia 27 (suppl). S45-S5l.
6. BNF for Children (2008), BMJ Publishing Group Ltd.
7. SCHLUMBERGER, E., CHAVEZ, F., PALACIOS, L. et al (1994) Lamotrigine in treatment of l20 children with

epilepsy. Epilepsia 35, 359-367.
8. BESAG, F.M.C., WALLACE, S.J., DULAC, O. et al (1995) Lamotrigine for the treatment of epilepsy in childhood.

J Pediatr 127, 99l-997.
9. COPPOLA, G., AURICCHIO, G., FEDERICO, R. et al (2004) Lamotrigine versus valproic acid as first-line

monotherapy in newly diagnosed typical absence seizures: an open-label, randomized, parallel-group study.
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10. APPLETON, R.E., PETERS, A.C.B., MUMFORD, J.P. et al (1999) Randomised, placebo-controlled study of
vigabatrin as first-line treatment of infantile spasms. Epilepsia 40, 1627-1633.
11. MACKAY, M.T., WEISS, S.K., ADAMS-WEBER, T. et al (2004) Practice parameter: medical treatment of
infantile spasms: report of the American Academy of Neurology and the Child Neurology Society. Neurology 62,
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12. National Institute for Clinical Excellence (NICE) (2012) Guidelines for the diagnosis and management of epilepsy
in adults and children in primary and secondary care. www.nice.org.uk/CG137.
13 AICARDI, J., MUMFORD, J.P., DUMAS, C. et al (1996) Vigabatrin as initial therapy for infantile spasms  a
European retrospective study. Epilepsia 37, 638-642.
14. HANCOCK, E., OSBORNE, J.P. and MILNER, P. (2002) Treatment of infantile spasms (Cochrane Review): The
Cochrane Library. Oxford: Update Software
15 CHIRON, C., DUMAS, C., JAMBAQUE, I. et al (1997) Randomised clinical trial comparing vigabatrin and
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