Treatment of pediatric epilepsy

ABSTRACT Pediatric epilepsy is a neurological disorder arising from various etiologies, including structural, genetic, immune, infectious, metabolic, and unknown causes. Anti‐seizure medications remain the primary treatment; however, in cases of drug‐resistant epilepsy, surgical interventions, ketogenic diet, and emerging therapies have become increasingly effective options. Disease‐modifying treatments, such as antisense oligonucleotides and adeno‐associated virus–mediated gene replacement, have shown promise in some epilepsy treatments, with early trials reporting moderate seizure reduction. Minimally invasive surgical approaches, including magnetic resonance–guided laser interstitial thermal therapy, have also demonstrated favorable outcomes, showing a 68% seizure‐free rate at 2 years in the largest pediatric series. Although the ketogenic diet is effective in some patients, demonstrating superiority over conventional management for >50% seizure reduction, long‐term use may be associated with metabolic risks; careful monitoring is warranted. Future treatment strategies are expected to emphasize personalized medicine through the integration of genetic, electrophysiological, and neuroimaging data to optimize therapeutic decision‐making and enable targeted interventions based on the underlying etiology.