Myoclonic Seizures in Children Under 16 — After Combination Antiepileptic Therapy Has Not Achieved Seizure Freedom
This protocol addresses children younger than 16 years of age with myoclonic seizures in the setting of progressive myoclonic epilepsy. The clinical goal is decreased frequency or elimination of seizures.
Previous treatment — goal not reached
Combination therapy using two or more antiepileptic drugs was the initial approach, with a target of freedom from seizures. When that target is not achieved, an escalated treatment path is indicated.
Next-step approach — partial overview
For children whose seizures remain uncontrolled after antiepileptic combinations, the next step involves nonpharmacologic interventions — approaches that either target the seizure focus directly or alter physiological conditions that sustain seizure activity. The complete structured protocol specifies which options apply and how to select among them.
References
- For patients with seizures that are not controlled with these agents, alternative treatments include surgical resection of the seizure focus, ketogenic diets, vagus nerve stimulators, and implantable brain neurostimulators.
- The ketogenic diet, a high-fat, low-carbohydrate, and low-protein diet, induces ketone body formation.
- Surgical resection of the seizure focus in appropriately selected patients often results in decreased frequency or elimination of seizures with improvement in quality of life.
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