Complex Partial Seizures in Children.

Abstract

The treatment of complex partial seizure (CPS) begins with accurate diagnosis. Episodes of staring and unresponsiveness due to nonepileptic causes must be ruled out. Absence seizures (typical and atypical petit mal) must be considered because the treatment strategy and prognosis for these seizures are very different from those for CPS. Diagnostic evaluation should include electroencephalography (EEG) done during both the awake and the sleep states. Standard activation procedures and high-quality magnetic resonance imaging (MRI) of the brain with sequences specifically designed to evaluate mesial temporal structures and subtle regions of cortical dysplasia should be used. Computed tomography is not adequate for brain imaging in the evaluation of persons with seizures. Because most children with CPS will not "grow out of their seizures" and only 50% will have seizures adequately controlled, early aggressive therapy should be pursued. The goal of therapy should be complete freedom from seizures. Although only a few antiepileptic drugs (AEDs) are specifically approved for CPS in children younger than 12 years of age, a variety of pharmacologic options exist. This is because 1) AEDs that are effective in any type of partial seizure are likely to be effective in CPS, 2) AEDs that are effective in adults with partial seizures are effective in children with seizures of the same type, and 3) AEDs that are effective as adjunct therapy can be effective as monotherapy. The choice of an AED should be strongly influenced by side-effect profiles because it is not yet possible to predict which AED will be most effective in an individual child or adolescent. Surgical resection should be considered for children of all ages if seizures are intractable to adequate medical intervention, especially if a structural abnormality is detected on neuroimaging.