Childhood Onset Epilepsy
NICE guideline [NG217] Epilepsies in children, young people and adults – 6. Treating childhood-onset epilepsies. Last updated: Jan 2025.
Guidelines
Management
Infantile spasms syndrome (West syndrome) is most frequently featured in exam questions, due to its typical clinical & diagnostic presentation.
However, this article also summarises the other syndromes addressed in the current guideline.
Dravet Syndrome
- 1st line: sodium valproate
- 2nd line: triple therapy with sodium valproate + stiripentol + clobazam
Note that the MHRA safety measures and precautionary advice state that sodium valproate should NOT be started in both males and females who are <55 y/o.
However, sodium valproate is still recommended as 1st line due to the severity of Dravet syndrome and lack of other effective 1st line treatment options.
Lennox-Gastaut Syndrome
- 1st line: sodium valproate
- 2nd line: lamotrigine (monotherapy or add to sodium valproate)
Note that the MHRA safety measures and precautionary advice state that sodium valproate should NOT be started in both males and females who are <55 y/o.
However, sodium valproate is still recommended as 1st line due to the severity of Lennox-Gastaut syndrome and lack of other effective 1st line treatment options.
Infantile Spasms Syndrome (West Syndrome)
- 1st line: vigabatrin + prednisolone (high-dose)
- If secondary to tuberous sclerosis:
- 1st line: vigabatrin monotherapy
- 2nd line: add high-dose prednisolone
Self-Limited Epilepsy with Centrotemporal Spikes (formerly Benign Rolandic Epilepsy)
- 1st line: lamotrigine or levetiracetam monotherapy
- 2nd line: carbamazepine or oxcarbazepine or zonisamide monotherapy
Doose Syndrome (Epilepsy with Myoclonic-Atonic Seizures)
- 1st line: sodium valproate or levetiracetam
- 2nd line: ketogenic diet monotherapy or add-on treatment
Note that the MHRA safety measures and precautionary advice state that sodium valproate should not be started in both males and females who are <55 y/o.