XXASIM May p159-165

159 W ith new antiepileptic drugs (AEDs) released at a rate of nearly 1 per year for the past decade, clinicians have been blessed with—and occasionally confused by—a growing list of medical treatment options for the child with epilepsy. The AEDs added since 1993 include: felbamate, gabapentin, lamotrigine, topiramate, tiagabine, oxcarbazepine, levetiracetam, and zonisamide. These new drugs have greatly expanded the range of alternatives to the standard AEDs and their unfavorable side-effect profiles and potential drug interactions. Many of the new choices do not have specific pediatric indications, pharmacokinetic information, and side-effect data, and they cannot boast a long track record of clinical use. Despite these factors, the new agents are of necessity playing valuable roles in everyday clinical practice. This is especially true in cases where the child has failed to achieve satisfactory control after treatment with a firstor second-choice medication such as phenytoin, carbamazepine, valproate, ethosuximide, or phenobarbital/primidone. Although the new AEDs lack a solid scientific base of evidence, such as Class I, clinicians still require information to guide their decision making with regard to the wealth of AED choices for refractory seizures. This article attempts to translate clinical experience into such guidance, first by reviewing key differences between childhood and adult epilepsy and then by suggesting a seizureand syndrome-specific approach to AED selection in children.