Valproate in the treatment of epilepsies in children

Abstract

The treatment of epilepsy with valproate in childhood must take into account the wide range of clinical presentations of epilepsy, including specific responses to the drug, and pharmacological and toxicological particularities in this age range. Particularities of epilepsies in infancy and childhood Aetiology In childhood as in adulthood, epilepsy may result from cerebral lesions, particularly of prenatal occurrence, abnormalities of the program and development of the brain, or of peri-or postnatal occurrence, of clastic, vascular, traumatic, infectious, or toxic origin (including endogenous due to inborn errors of metabolism). Tumours are rare, causing less than 1 % of epilepsies in the first decade [1]. In fact, less than one-quarter of childhood epilepsies are due to some cause identifiable by history, clinical examination or neuroradiological investigation. A genetic predisposition can be demonstrated or suspected in nearly half the cases, and it can be either the only causative factor without any evidence of anatomic brain damage, or produce by itself specific brain lesions such as dysplasia or vascular malformations [2]. The third factor which is specific to childhood is due to maturation phenomena, since there are age ranges that are at particular risk for the occurrence of certain types of epilepsy, with spontaneous tendency for seizures to become less severe and frequent in the long term [3]. These three groups of etiologic factors account for the epilepsy either independently or in combination, resulting in a wide range of clinical expressions of disease. In particular, the expression of epilepsy may vary for a given aetiology, according to other factors-genetic or maturational predisposition.