Treating myoclonic epilepsy in children: state-of-the-art.

INTRODUCTION: Myoclonic seizures can be observed in various clinical settings and different epileptic conditions, including some forms of both diopathic and symptomatic epilepsies. Relatively little has been written on treatment of myoclonic seizures. Some old antiepileptic drugs, such as valproate and some benzodiazepines, are widely used but more treatment options exist today for some newer antiepileptic drugs. Nevertheless, patients can be refractory to drug treatment and some drugs may exacerbate or even induce myoclonus.

AREAS COVERED: Key safety, tolerability, and efficacy data are presented for different antiepileptic drugs with antimyoclonic effect, alone and/or in combination.

EXPERT OPINION: Treatment of myoclonic seizures in children is mainly based on prospective and retrospective studies, with little evidence from randomized clinical trials. Valproate is commonly the first choice alone or in combination with some benzodiazepines or levetiracetam. There is still insufficient evidence for the use of topiramate and zonisamide as monotherapy. Of major importance remains avoidance of medication that may aggravate the seizures. Better understanding of pathophysiologic mechanisms of myoclonic seizures and myoclonic epilepsies could yield great improvement in the treatment and quality of life of patients.