# Treatment of pediatric epilepsy

## TL;DR

This paper reviews treatment options for pediatric epilepsy, including medications, surgery, diet, and emerging therapies like gene therapy.

## Contribution

The paper highlights the potential of disease-modifying therapies and personalized medicine in treating pediatric epilepsy.

## Key findings

- Minimally invasive surgery showed a 68% seizure-free rate at 2 years in pediatric cases.
- Ketogenic diet can reduce seizures by more than 50% but carries metabolic risks.
- Gene therapy and antisense oligonucleotides show promise in early trials for treating epilepsy.

## Abstract

Pediatric epilepsy is a neurological disorder arising from various etiologies, including structural, genetic, immune, infectious, metabolic, and unknown causes. Anti‐seizure medications remain the primary treatment; however, in cases of drug‐resistant epilepsy, surgical interventions, ketogenic diet, and emerging therapies have become increasingly effective options. Disease‐modifying treatments, such as antisense oligonucleotides and adeno‐associated virus–mediated gene replacement, have shown promise in some epilepsy treatments, with early trials reporting moderate seizure reduction. Minimally invasive surgical approaches, including magnetic resonance–guided laser interstitial thermal therapy, have also demonstrated favorable outcomes, showing a 68% seizure‐free rate at 2 years in the largest pediatric series. Although the ketogenic diet is effective in some patients, demonstrating superiority over conventional management for >50% seizure reduction, long‐term use may be associated with metabolic risks; careful monitoring is warranted. Future treatment strategies are expected to emphasize personalized medicine through the integration of genetic, electrophysiological, and neuroimaging data to optimize therapeutic decision‐making and enable targeted interventions based on the underlying etiology.

Anti‐seizure medications are the first‐line treatment for the vast majority of children with epilepsy, with the advantages of non‐invasive wide adaptability. Surgery is the main treatment for drug‐resistant epilepsy and lesion‐related epilepsy, which can cure some cases of epilepsy in children. A ketogenic diet is often an add‐on therapy. Gene therapy and disease modification therapy may bring new hope to pediatric epilepsy.