Paediatric Epilepsy: Current Advances in Diagnosis and Management

Abstract

Paediatric epilepsy is one of the most common chronic neurological disorders of childhood, characterised by recurrent unprovoked seizures resulting from abnormal neuronal activity. Accurate diagnosis is essential and is based on a detailed clinical history, seizure semiology, neurological examination, and electroencephalography (EEG), with neuroimaging such as magnetic resonance imaging (MRI) used to identify structural abnormalities. Classification according to seizure type and underlying aetiology genetic, structural, metabolic, immune, infectious, or unknown—guides appropriate management strategies. The primary goal of treatment is to achieve optimal seizure control while minimising adverse effects and supporting normal neurodevelopment. First-line management typically involves antiseizure medications (ASMs) selected according to seizure type, patient age, comorbidities, and potential drug interactions. Approximately two-thirds of affected children achieve seizure remission with pharmacological therapy. However, a significant proportion develop drug-resistant epilepsy (DRE), requiring alternative approaches such as ketogenic diet therapy, vagus nerve stimulation, or epilepsy surgery. Early identification of DRE is critical to reduce the risk of cognitive, behavioural, and psychosocial impairment. Comprehensive care extends beyond seizure management and includes addressing developmental, educational, and psychosocial needs. A multidisciplinary, family-centred approach involving neurologists, dietitians, psychologists, and educators is essential. Advances in genetic testing and precision medicine are improving diagnostic accuracy and enabling more personalised treatment strategies in (PE).