Epilepsy CurrentsAES ILAE North America Symposium: Guiding Evidence-Based Epilepsy Management

New ILAE and NSGC consensus guidance calls for earlier genetic testing, faster surgical referral, and universal anxiety/depression screening in pediatric epilepsy.

🔬 Clinical Considerations

• Exome or genome sequencing now recommended first-tier for all unexplained epilepsy regardless of age; diagnostic yield for GS reaches 48% versus 7% for small multigene panels
• Referral after 2 failed ASMs is now the consensus threshold for epilepsy surgery evaluation; delays increase injury risk, cognitive decline, and mortality without improving medication outcomes
• Phenobarbital confirmed as first-line ASM for neonatal seizures; NeoLEV trial showed phenobarbital significantly outperformed levetiracetam at 1 and 24 hours post-administration
• Universal anxiety and depression screening recommended annually for all pediatric epilepsy patients beginning at age 7; unaddressed comorbidities worsen seizure control and medication adherence
• UK Epilepsy12 audit data confirm guidelines improve care processes, but surgical referral rates remain stubbornly low, highlighting persistent implementation gaps

🎯 Practice Applications

• Order exome or genome sequencing as first-tier testing for any patient with unexplained epilepsy before pursuing smaller panels
• Refer patients failing a second appropriate ASM to a specialized epilepsy center without waiting for further medication trials
• Implement standardized annual mental health screening at age 7+ for all pediatric epilepsy patients using validated, age-appropriate instruments
• Discontinue ASMs before discharge following acute provoked neonatal seizures without evidence of neonatal-onset epilepsy

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