New anti-epileptic drugs in treating the epilepsies of childhood

The treatment of epilepsy in children begins with the correct diagnosis of epilepsy and identification of the epilepsy syndrome and any underlying cause. Seizure control is clearly important and, in most children, is probably the key factor in determining their quality of life, but this should not be at the expense of the child's general health and ability to function, both in and out of school. The introduction of the newer anti-epileptic drugs has obviously improved the seizure control of many children with epilepsy but none of these drugs have yet replaced the older drugs, specifically sodium valproate and carbamazepine. In addition, the use of these new drugs has paradoxically (but not unexpectedly) contributed to a therapeutic confusion that may occasionally result in the inappropriate treatment of some of the paediatric epilepsies. Finally, there remains a clear need to undertake robust but pragmatic clinical trials of any novel and emerging anti-epileptic drugs in children as well as in adults.