Epilepsy Center | Treatments

A new generation of epilepsy treatments

The past two decades have seen a host of new anti-epileptic drugs come on the market. While these new drugs aren’t able to eliminate seizures in all children, they do give us new options to try when first-line drugs aren’t working. Many of the new drugs work through completely different mechanisms, giving new strategies to control seizures, often with fewer side effects.

Some of the medications in the chart below are not yet FDA-approved for children but are often used at Boston Children’s Hospital. Two additional medications not on the chart, stiripentol (Diacomit®) and sulthiame (Ospolot®), are not yet commercially available in the United States but can be made available to some children with specific types of epilepsies.

Compared to the pre-1990 drugs, many of the newer drugs have a broader range of action, making them more likely to work for generalized seizures. However, some of them, like gabapentin, pregabalin, oxcarbazepine and tiagabine, seem to work only for seizures that have a focal onset.

The newer drugs tend to be less sedating, have fewer adverse effects on memory and learning, and are less likely to cause allergic reactions and serious side effects.  But there are still some exceptions to be aware of:

  • Cognitive side effects remain a concern with topiramate.
  • Felbamate can potentially cause aplastic anemia or liver failure.
  • Vigabatrin can permanently reduce a child’s field of vision.
  • Stevens-Johnson syndrome, a severe allergic drug reaction, remains a concern with lamotrigine.

Another benefit of the newer drugs is that they tend not to interact with other medications or each other. However, some of the older drugs do affect the metabolism of some of the newer drugs.

When medications fail

Unfortunately, even with all these new medications, some children still have seizures that remain difficult to control. Recently, however, research findings have created new opportunities to fine-tune and individualize medical treatment to help control seizures. Possible options include:

  • Chronotherapy: Sometimes it can help to give medications at specific times of the day, in step with a child’s daily pattern of seizures. For example, overnight EEG studies sometimes reveal spikes in epilepsy-like activity during sleep that might respond to high doses of Valium or other medications taken at bedtime.
  • Genetically tailored treatments: Through DNA sequencing, Boston Children’s Hospital’s Epilepsy Genetics Program is discovering previously unknown genetic causes of seizures. Some of these disrupt brain biochemistry in a way that can be targeted with drugs.
  • Pharmacogenomics: Genetic differences in metabolism may affect how well certain drugs work and their side effects. The Epilepsy Center at Boston Children’s is studying these genetic differences and children’s responses to different medications. This information will help us choose the optimal treatment for each child.

If your child has seizures that aren’t controlled well by medications, you may want to explore some of these options with your care team. Your child may be eligible for one of our ongoing research studies that are investigating these new treatment approaches.