50 Years Ago in The Journal of Pediatrics:
The treatment of the epileptic child
Article Outline
Hughes JG, Jabbour JT. J Pediatr 1958;53:66-88
“Change is eternal” is a quote ascribed in various forms over the centuries to great thinkers, from the Greek philosopher Heraclitus to the British statesman and writer Benjamin Disraeli. But were they right? Perhaps not always, if we examine the earlier writings of epileptologists.
50 years ago in The Journal, Hughes and Jabbour detailed the management of the epileptic child. Although their words may at times seem archaic or reflect their era, their approach is really no different today: “1) investigation of etiology; 2) attempt to define the areas of the brain involved; 3) classification of types of seizures; and 4) methods of treatment.” They conclude, “Modern treatment emphasizes 4 avenues of approach: 1) drug therapy; 2) prevention, detection, and correction of psychologic distortion [‘Therefore, efforts to prevent or correct maladjustment are not only Christian kindness but also a calculated part of treatment']; 3) good general hygiene and proper diet [‘As in no other disease, in epilepsy an idle mind is the devil's worship']; 4) in selected cases, neurosurgical excision of the epileptic focus.”
Although the facts about seizure management remain essentially unchanged, the names of drugs particularly have changed. Fewer and fewer of us can claim using mephobarbital, methosuximide, paraldehyde, primidone, or phenacemide, which have yielded to newer agents with improved efficacy and lesser adverse effects, such as oxcarbazepine, levetiracetam, topiramate, lamotrigine, or zonisamide. Pediatricians must become familiar with these drugs, which are new to many since residency.1
Perhaps the authors' most prescient insight is “Sometimes seizures are controlled by drugs not supposed to be the agents of choice.” Not only have the names of drugs changed, but also has their range of efficacy widened considerably. In particular, the “second-generation” drugs lamotrigine, topiramate, and levetiracetam are now considered to be broad-spectrum anti-epileptic drugs, in an evolution analogous to what was seen decades ago with the development of the cephalosporins for bacterial infections.2 Although Hughes and Jabbour lacked these anti-convulsants, I expect that they would have quickly incorporated these agents in their approach, which we still use today. Even non-neurologists would do well to understand their treatment paradigm and become comfortable prescribing the newer and simpler medications with broader efficacy and lesser toxicity. The drug names have changed, although the story remains the same.
References
PII: S0022-3476(08)00089-9
doi:10.1016/j.jpeds.2008.02.003
© 2008 Mosby, Inc. All rights reserved.
