When First-Line Antiepileptic Monotherapy Fails to Achieve Seizure Freedom in Children Under 16 with Myoclonic Seizures
Clinical scenario
This protocol addresses children younger than 16 years of age with myoclonic seizures in the setting of progressive myoclonic epilepsy. The overriding treatment goal is complete freedom from seizures.
First-line treatment did not reach the goal
An initial course of monotherapy with an indicated antiepileptic drug, individualised to the patient, was trialled. The target — freedom from seizures — was not achieved. This failure of single-agent therapy defines the escalation point that brings this protocol into scope.
Next-step approach
Once monotherapy has proven insufficient, the next step draws on combination therapy — using two or more of the indicated antiepileptic drugs. Which agents are combined, and how treatment is individualised to the patient, is detailed in the full protocol.
Target: Freedom from seizures
References
- Monotherapy with all indicated AEDs should be attempted before initiating combination therapy.
- When patients have been seizure free for two to five years, discontinuation of antiepileptic drugs may be considered.
- Children (younger than 16 years)
- Myoclonic
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