Mathura Kannan

Treatment of Pediatric Epilepsy: Systematic Review

Started Jan. 30, 2025

Abstract or project description

Pediatric epilepsy affects nearly 470,000 children in the United States and millions more globally, with approximately 30% experiencing drug-resistant epilepsy. Timely and effective treatment is critical to prevent long-term neurodevelopmental complications. There is currently no effective disease modifying therapy for epilepsy and patients therefore often suffer high drug burden. Anti-seizure medications (ASMs) are a cornerstone of epilepsy treatment; these drugs modulate ion channels on pre- and postsynaptic neuron membranes. This paper reviews the current landscape of non-surgical treatments for pediatric epilepsy, including both first- and second-generation ASMs, dietary interventions like the ketogenic diet (KD), and a focused evaluation of levetiracetam (Keppra). Benzodiazepines such as clobazam and midazolam provide effective control in both chronic and acute settings. GABAergic agents like gabapentin and vigabatrin offer additional options, although vigabatrin’s risk of irreversible vision loss limits its long-term use. Sodium channel blockers including lamotrigine and lacosamide continue to be mainstays in partial seizure treatment, while topiramate and valproic acid offer broad-spectrum efficacy. Keppra stands out among newer ASMs due to its favorable efficacy, low interaction profile, and mild side effect burden. The KD and its variants, like the Modified Atkins Diet and the Low Glycemic Index Treatment, have emerged as effective adjunct therapies in drug resistant epilepsy, with over 50% of patients achieving meaningful seizure reduction. The combination of Keppra with KD may yield synergistic benefits, possibly due to overlapping and complementary mechanisms involving neurotransmitter regulation and metabolic stabilization. This paper highlights the need for further clinical research to optimize combination strategies for Keppra and KD, particularly for pediatric patients unresponsive to monotherapy.