Clinical features and ethical issues in pediatric epilepsy

Worldwide, fifty million people have epilepsy and around 85 % of them live in developing countries. In particular, 25% of the global population with epilepsy is younger than 15 years of age. Prognosis in children with epilepsy varies from benign epilepsies in which remission occurs after a few years and treatment can often be avoided, to patients with drug-resistant seizures, which may require polytherapy and even surgical treatment. Due to the wide range of causes of epileptic syndromes, the possible negative psychosocial and cognitive consequences of seizures and the impact on quality of life, the management of children with epilepsy raises some relevant ethical issues: communication of diagnosis, the decision of starting a treatment after the first seizure, the use of new drugs in children and diagnostic challenges. Although surgery represents a viable therapeutic option for children with refractory focal epilepsy, the widespread use of surgical intervention must be regulated by evidence-based outcomes, pragmatism, and ethical principles. The cooperative work of neurologists, psychologists, caregivers and teachers can help face the challenges related to epilepsy, including the persisting stigma.