Optimizing Antiseizure Medication Regimens in Adults

Developmental and epileptic encephalopathies (DEEs) are a group of rare epilepsies characterized by seizures and neurodevelopmental regression or delay, often presenting in infancy and frequently resistant to conventional antiseizure medications (ASMs). Even when seizure control improves, neurodevelopmental impairments may persist or progress, necessitating long-term multidisciplinary care and active involvement from families in care coordination. Transition from pediatric to adult care may require individualized planning that addresses both seizure management and broader medical, cognitive, educational, and psychosocial needs of patients with DEEs.¹

In this NeurologyLive® Special Report video program, Joseph Sullivan, MD, the director of the Pediatric Epilepsy Center of Excellence at the University of California San Francisco, discussed key considerations in the transition of care from pediatric to adult epilepsy management. He highlighted strategies to support patients during this process, including effective communication between care teams. Sullivan also addressed the role of genetic testing and the importance of reassessing treatment plans over time. He discussed approaches to optimizing ASMs and the potential use of surgical or neuromodulation interventions. Additionally, he emphasized the importance of reviewing diagnoses and treatments over time to ensure care stays aligned with evolving clinical knowledge.

In this third episode, Sullivan emphasized the transition of patients with childhood-onset epilepsies to adult care, noting that adult epilepsy providers are increasingly managing cases of DEE without prior diagnoses. He talked about how advances in genetic testing and emerging therapies may prompt patients and clinicians to pursue testing more proactively. Sullivan highlighted how pattern recognition from pediatric experience can guide adult providers in identifying candidates for genetic testing, ultimately improving diagnosis and treatment opportunities.

REFERENCE
1. Nabbout R. Transition of care in developmental & epileptic encephalopathies (DEE). J Neurol Sci. 2023;455(Suppl):120907. doi:10.1016/j.jns.2023.120907.

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