Epilepsy CurrentsAmerican Epilepsy Society Clinical Practice Guideline: Infantile Epilepsy

✅ Guideline Update

The American Epilepsy Society published the first dedicated treatment guideline for infantile epilepsy covering ages 1 month to <36 months, excluding infantile spasms. Two strong surgical recommendations anchor the document; pharmacological and dietary recommendations are mostly conditional with low-certainty evidence.

Clinical Considerations

• Hemispherectomy/hemispherotomy strongly recommended for drug-resistant epilepsy from hemimegaloencephaly, Rasmussen’s, Sturge-Weber, perinatal stroke, or hemispheric cortical dysplasia.
• Genetic testing recommended before valproate to exclude POLG variants given hepatotoxicity risk in children under 2.
• Levetiracetam preferred over phenobarbital for new-onset; oxcarbazepine preferred over levetiracetam for new-onset focal epilepsy.
• Classic ketogenic diet preferred over modified Atkins in this age group; consider as first-line in GLUT1 deficiency or PDH.

Practice Applications

• Refer drug-resistant cases early to specialized epilepsy centers for surgical evaluation.
• Order genetic testing before initiating valproate in unknown-etiology infantile epilepsy.
• Recognize most recommendations remain conditional and based on low-certainty evidence.
• Reassess etiology and surgical candidacy when seizures persist after two appropriate ASMs.

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