When considering the most appropriate choice
of treatment, it is essential to be confident about the
diagnosis and underlying etiology. This is of particu-lar importance in children with refractory epilepsy,
a large proportion of whom present specific age-dependent epilepsy syndromes. Accurate identifica-tion of the epilepsy syndrome is the foundation for the
choice of an appropriate treatment and increases the
likelihood of seizure remission.
18
In some instances,
identifying etiologies can radically alter the potential
treatment options, for example metabolic treatments
such as the ketogenic diet for epilepsies resulting
from IEM.
19
Surgery may be the most appropriate
treatment option in some cases, especially where
strong evidence exists for its efficacy, such as for the
anterior temporal lobectomy in drug-resistant tem-poral lobe epilepsy.
20
However, the most appropriate
timing for surgery remains debated. When surgery
is not a suitable treatment option, neurostimulation
therapies such as vagus nerve stimulation (VNS) may
be considered