What are the pediatric anti-epileptic (antiepileptic) medications?

From the Guidelines

Pediatric antiepileptic medications include levetiracetam, lorazepam, and phenobarbital, with levetiracetam being a preferred option due to its favorable side effect profile, as seen in the management of status epilepticus in pediatric patients receiving chimeric antigen receptor T cell therapy 1.

Key Medications

• Levetiracetam: 40 mg/kg (maximum 2,500 mg) i.v. bolus, with maintenance doses of 15-30 mg/kg i.v. every 12 hours 1
• Lorazepam: 0.05-0.1 mg/kg (maximum 1-2 mg) i.v., repeated as needed to control seizures 1
• Phenobarbital: 10-20 mg/kg (maximum 1,000 mg) i.v. loading dose, with maintenance doses of 1-3 mg/kg i.v. every 12 hours 1

Considerations

• Medication choice depends on seizure type, patient age, comorbidities, and potential side effects
• Regular monitoring of drug levels, complete blood counts, and liver function is crucial, as children may metabolize these medications differently than adults
• Antiepileptic drugs work by various mechanisms, including sodium channel modulation, GABA enhancement, or glutamate inhibition to stabilize neuronal membranes and prevent the abnormal electrical activity that causes seizures

Additional Options

• Valproic acid and carbamazepine may also be considered, as recommended by the WHO for the management of epilepsy in low- and middle-income countries 1
• However, these medications may have different side effect profiles and requirements for monitoring, and their use should be individualized based on patient needs and circumstances.

From the FDA Drug Label

The effectiveness of levetiracetam as adjunctive therapy (added to other antiepileptic drugs) in pediatric patients was established in one multicenter, randomized double-blind, placebo-controlled study, conducted at 60 sites in North America, in children 4 to 16 years of age with partial seizures uncontrolled by standard antiepileptic drugs (AEDs) Adjunctive Therapy Controlled Trial in Pediatric Patients Ages 2 to 16 Years With Partial Onset Seizures The effectiveness of topiramate as an adjunctive treatment for pediatric patients ages 2 to 16 years with partial onset seizures was established in a multicenter, randomized, double-blind, placebo-controlled trial, comparing topiramate and placebo in patients with a history of partial onset seizures, with or without secondarily generalized seizures.

The pediatric anti-epileptic medications are:

• Levetiracetam: effective as adjunctive therapy in children 4 to 16 years of age with partial seizures uncontrolled by standard antiepileptic drugs 2
• Topiramate: effective as an adjunctive treatment for pediatric patients ages 2 to 16 years with partial onset seizures 3

From the Research

Pediatric Anti-Epileptic Medications

The following are some of the pediatric anti-epileptic medications:

• Carbamazepine: considered as first-line antiepileptic therapy for children with partial seizures 4
• Valproic acid: considered as first-line antiepileptic therapy for children with partial seizures and generalized onset seizures 4, 5
• Oxcarbazepine: effective as adjunctive or first-line monotherapy for pediatric partial seizures 4
• Topiramate: effective as adjunctive or first-line monotherapy for pediatric partial seizures 4
• Gabapentin: effective as adjunctive or first-line monotherapy for pediatric partial seizures 4
• Lamotrigine: effective as adjunctive or first-line monotherapy for pediatric partial seizures and generalized onset seizures 4, 5
• Levetiracetam: effective as first-line monotherapy for childhood epilepsy 6, 7, 5
• Phenytoin: mostly considered as last choice drug due to its adverse event profile 4
• Phenobarbital: mostly considered as last choice drug due to its adverse event profile 4
• Vigabatrin: effective for epileptic spasms, but its use is limited due to the risk of visual field constriction 4, 8
• Zonisamide: may be effective for pediatric partial seizures, but more data are needed to support its use 4, 5

Seizure Type and Medication Choice

The choice of anti-epileptic medication depends on the type of seizure:

• Epileptic spasms: steroids and vigabatrin are the most effective treatment options 8
• Absence seizures: ethosuximide and valproic acid are superior to lamotrigine 8
• Focal seizures: many newer AEDs have favorable side effect profiles with efficacy comparable to older-generation drugs 8
• Generalized epilepsies: valproic acid remains the most effective drug for a broad range of seizure types 8