Aug 2026· Expert Opinion on Pharmacotherapy· pp. 1-13· 0 citations· 85 references
Medicine
TL;DR
Current and emerging pharmacotherapeutic options for selected representative pediatric focal epilepsies are summarized using a syndrome- and localization-oriented approach, highlighting conventional antiseizure medications, newer agents, and investigational or repurposed treatments.
Abstract
INTRODUCTION
Pediatric focal epilepsies comprise a heterogeneous group of disorders, ranging from self-limited childhood syndromes to severe drug-resistant forms associated with structural, genetic, immune, or unknown etiologies. Despite newer antiseizure medications, pediatric evidence remains largely extrapolated from heterogeneous focal-onset seizure trials, with limited syndrome- or localization-specific data.
AREAS COVERED
A structured iterative narrative search of PubMed, Scopus, and Embase was completed in May 2026 and supplemented by section-specific searches and manual reference screening. This review summarizes current and emerging pharmacotherapeutic options for selected representative pediatric focal epilepsies using a syndrome- and localization-oriented approach. We discuss self-limited focal epilepsies of childhood, frontal lobe epilepsy, and temporal lobe epilepsy, highlighting conventional antiseizure medications, newer agents, and investigational or repurposed treatments. Particular attention is given to drug resistance, comorbidities, rational polytherapy, and integration of pharmacological treatment with genetic diagnosis, neuroimaging, and surgical evaluation.
EXPERT OPINION
Management is moving from a purely seizure-based approach toward individualized, mechanism-informed care. Newer antiseizure medications expand therapeutic options, particularly in drug-resistant focal epilepsies, but should not delay etiological work-up or timely referral for epilepsy surgery. Future progress will require pediatric condition-specific trials, genotype-driven stratification, real-world data, and targeted therapies.
This critical narrative review synthesises evidence on the clinical features, aetiologies, and therapeutic options for these syndromes, and evaluates the strength, consistency, and limitations of that evidence rather than cataloguing individual studies.
S. Bittmann, E. Luchter, Elena Moschüring-Alieva· Asian Journal of Pediatric R...· 0 citations
Comprehensive care extends beyond seizure management and includes addressing developmental, educational, and psychosocial needs, and a multidisciplinary, family-centred approach involving neurologists, dietitians, psychologists, and educators is essential.
Jayesh S. Patil, Hitendra S. Chaudhari, S. Pawar et al.· Research and reviews : a jou...· 0 citations
Meckel’s Pediatric drug-resistant epilepsy (DRE) is a significant neurological disorder that develops when seizures persist despite treatment with two appropriately selected antiseizure medications. Although only a subset of children with epilepsy develops DRE, prolonged uncontrolled seizures during childhood can result in irreversible cognitive, behavioral, and developmental impairment. Over time, growing evidence has demonstrated that epilepsy surgery is an effective treatment for appropriately selected patients and that earlier surgical intervention is associated with improved relief from seizures and long-term neurodevelopmental outcomes. This review examines the mechanisms underlying pharmaco-resistance, including network reorganization, neuroinflammation, blood-brain barrier dysfunction, and structural abnormalities that contribute to epileptogenesis. Common surgically remediable causes of pediatric DRE, including focal cortical dysplasia, mesial temporal sclerosis, tuberous sclerosis complex, hemimegaloencephaly, and tumor-associated epilepsy, are discussed along with current surgical approaches, including resective, disconnective, and minimally invasive procedures. The evidence comparing early versus delayed surgical intervention is reviewed with emphasis on seizure control, cognitive development, language, behavior, and quality of life. Finally, this review highlights persistent barriers to timely surgical referral, including socioeconomic, geographic, and racial disparities, while exploring emerging advances in neuroimaging, artificial intelligence-assisted lesion detection, and imaging biomarkers that may improve early diagnosis and patient selection. Collectively, the available evidence supports earlier referral for surgical evaluation in children with DRE and suggests that prompt intervention may preserve neurodevelopment, improve long-term functional outcomes, and maximize quality of life.
Tyler L. Williams, Spencer Collins, Edgar Sanchez et al.· Journal of Surgical Research· 0 citations
This review synthesizes advances in neuroimmunology, clinical phenotyping, diagnostics, immunomodulatory and antiseizure therapies, neuromodulation, and patient and family centered outcomes, and outlines future directions focused on biomarker-driven precision medicine, disease-modifying strategies, and interdisciplinary care models.
Alica M. Goldman, Nora Wong, A. Vezzani et al.· Epilepsy Currents· 0 citations
This review examines the evolving landscape of pediatric OLE, highlighting the shift from syndromic to etiological classification and management strategies and the need to monitor cognitive comorbidities and syndrome evolution.
Preeti Srivastava, D. Nag, Shikha Swaroop et al.· World Journal of Clinical Pe...· 0 citations
