From the Guidelines
Pediatric antiepileptic medications should include levetiracetam, lorazepam, and phenobarbital as part of the treatment regimen, with dosages tailored to the patient's specific needs and seizure type. When considering antiepileptic medications for pediatric patients, it's crucial to assess the type of seizure, the patient's age, and the potential side effect profile of the medication.
- Levetiracetam is recommended at a dose of 15 mg/kg (maximum 1,500 mg) i.v. every 12 hours for maintenance, as seen in the management guidelines for pediatric patients receiving chimeric antigen receptor T cell therapy 1.
- Lorazepam is used at a dose of 0.05 mg/kg (maximum 1 mg) i.v. every 8 hours for 3 doses, also based on the guidelines 1.
- Phenobarbital is administered at a dose of 1–3 mg/kg i.v. every 12 hours, as part of the maintenance regimen 1. These medications are chosen based on their efficacy in controlling seizures and their safety profile in pediatric patients. It's essential to monitor drug levels regularly and adjust the dosage as needed to achieve seizure control while minimizing side effects. In addition to these medications, other antiepileptic drugs like carbamazepine, oxcarbazepine, and valproic acid may be considered based on the specific type of seizure and patient characteristics. However, the choice of medication should always prioritize the patient's safety and the potential for minimizing morbidity, mortality, and improving quality of life. The treatment should start with monotherapy at a low dose, gradually titrating up until seizure control is achieved or side effects occur, as is standard practice in pediatric epilepsy management. Regular follow-up and monitoring are crucial to adjust the treatment plan as needed and to ensure the best possible outcome for the patient.
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)
The pediatric antiepileptics (Anti-Epileptic Drugs (AEDs)) mentioned are:
- Levetiracetam Key points:
- Levetiracetam is used as adjunctive therapy in pediatric patients with partial seizures.
- The study was conducted in children 4 to 16 years of age.
- Levetiracetam was added to other antiepileptic drugs (AEDs) in the study 2.
From the Research
Pediatric Antiepileptics
The following are some of the pediatric antiepileptics (Anti-Epileptic Drugs (AEDs)) mentioned in the studies:
- Carbamazepine 3, 4, 5
- Valproic acid 3, 4, 5, 6
- Phenobarbital 3, 4, 5
- Phenytoin 3, 4, 5
- Oxcarbazepine 3, 7, 4, 5
- Lamotrigine 3, 7, 4, 5, 6
- Gabapentin 3, 4, 5
- Topiramate 3, 7, 4, 5, 6
- Levetiracetam 7, 4, 5, 6
- Zonisamide 7, 4, 5, 6
- Vigabatrin 3
- Tiagabine 3
- Felbamate 3
First-Line Treatments
Some of the studies mention the following as first-line treatments for pediatric epilepsy:
- Carbamazepine and lamotrigine for partial onset seizures 4, 5
- Sodium valproate for generalized onset seizures 4, 5
- Valproate, lamotrigine, topiramate, levetiracetam, and possibly zonisamide as broad spectrum anti-epileptic drugs 6
Efficacy and Safety
The studies discuss the efficacy and safety of various AEDs in children, including:
- Levetiracetam performing significantly better than carbamazepine and lamotrigine for partial seizures 4, 5
- Sodium valproate performing significantly better than carbamazepine, topiramate, and phenobarbitone for generalized onset seizures 4, 5
- Phenobarbitone performing worse than all other treatments for both partial and generalized onset seizures 4, 5
- The most commonly reported adverse events across all drugs, including drowsiness/fatigue, headache or migraine, gastrointestinal disturbances, dizziness/faintness, and rash or skin disorders 4, 5