Despite the emergence of new antiepileptic drugs, 10 to 20%of children with e pilepsy, half of whom have localization related epilepsy, remain refractory to drug treatment. Careful syndromic identification is essentia...Despite the emergence of new antiepileptic drugs, 10 to 20%of children with e pilepsy, half of whom have localization related epilepsy, remain refractory to drug treatment. Careful syndromic identification is essential before retaining t he diagnosis of intractable childhood epilepsy in order to optimize treatment an d avoid iatrogenic worsening. The use of appropriate associations of new antiepi leptic drugs should lead to better control in some situations, but further studi es are still necessary. A significant number of children with medically intracta ble lo calization related epilepsy may benefit from surgical treatment. Becaus e of the cognitive consequences of epilepsy in children, the question of the app ropriate time for surgery is still debated; the current trend is for early surge ry in children. For many authors, intractability can be assessed after 18 months of evolution, and retained when seizures persist at a frequency of one or more a month despite more than two correctly administered antiepileptic drugs. In cas e of epileptogenic encephalopathy, time to surgery may be shorter. Early predict ive criteria of intractability have been identified by several cohort studies an d include the presence of frequent seizures at disease onset, status epilepticus , with the prevalence of certain etiologies such as encephalitis or neuronal mig ration disorders. Conversely, some children may develop late intractability afte r an early benign course; the identification or early predictive criteria is sti ll unclear in this situation.展开更多
文摘Despite the emergence of new antiepileptic drugs, 10 to 20%of children with e pilepsy, half of whom have localization related epilepsy, remain refractory to drug treatment. Careful syndromic identification is essential before retaining t he diagnosis of intractable childhood epilepsy in order to optimize treatment an d avoid iatrogenic worsening. The use of appropriate associations of new antiepi leptic drugs should lead to better control in some situations, but further studi es are still necessary. A significant number of children with medically intracta ble lo calization related epilepsy may benefit from surgical treatment. Becaus e of the cognitive consequences of epilepsy in children, the question of the app ropriate time for surgery is still debated; the current trend is for early surge ry in children. For many authors, intractability can be assessed after 18 months of evolution, and retained when seizures persist at a frequency of one or more a month despite more than two correctly administered antiepileptic drugs. In cas e of epileptogenic encephalopathy, time to surgery may be shorter. Early predict ive criteria of intractability have been identified by several cohort studies an d include the presence of frequent seizures at disease onset, status epilepticus , with the prevalence of certain etiologies such as encephalitis or neuronal mig ration disorders. Conversely, some children may develop late intractability afte r an early benign course; the identification or early predictive criteria is sti ll unclear in this situation.
