Antiepileptic drugs in children with developmental delays and behavioral problems

Opinion statement

Children with multiple handicaps, including developmental delays and behavioral problems, frequently have epilepsy that requires treatment. Different strategies should be used for acute treatment versus chronic treatment. Experience suggests that there is no true drug of choice that can be used for all children with epilepsy; however, seizure type, epilepsy syndrome, and likely efficacy and side effect spectrum of the antiepileptic drug (AED) will determine the best treatment for each child. In general, phenobarbital has posed multiple behavioral problems, and, thus, is less commonly used. Carbamazepine is the most frequently used drug for the treatment of partial seizures with or without secondary generalization, and valproate is the long established, broad spectrum AED for children with generalized convulsive and nonconvulsive seizures. Newer AEDs allow alternative treatments to those with adverse effects to the more frequently used medications and may have cognitive or behavioral advantages.