Childhood Onset Epilepsy

NICE guideline [NG217] Epilepsies in children, young people and adults - 6. Treating childhood-onset epilepsies. Last updated: Jan 2025.

Guidelines

  • 1st line: sodium valproate
  • 2nd line: triple therapy with sodium valproate + stiripentol + clobazam

 

Note that the MHRA safety measures and precautionary advice states that sodium valproate should NOT be started in both males and females that are <55 y/o.

However, sodium valproate is still recommended as 1st line due to the severity of Dravet syndrome and lack of other effective 1st line treatment options.

  • 1st line: sodium valproate
  • 2nd line: lamotrigine (monotherapy or add to sodium valproate)
 
 

Note that the MHRA safety measures and precautionary advice states that sodium valproate should not be started in both males and females that are <55 y/o.

However, sodium valproate is still recommended as 1st line due to the severity of Lennox-Gastaut syndrome and lack of other effective 1st line treatment options.

  • 1st line: vigabatrin + prednisolone (high-dose)
  • If due to tuberous sclerosis: 
    • 1st line: vigabatrin monotherapy
    • 2nd line: add high-dose prednisolone

  • 1st line: lamotrigine or levetiracetam monotherapy
  • 2nd line: carbamazepine or oxcarbazepine or zonisamide monotherapy

  • 1st line: sodium valproate or levetiracetam
  • 2nd line: ketogenic diet monotherapy or add-on treatment
 

Note that the MHRA safety measures and precautionary advice states that sodium valproate should not be started in both males and females that are <55 y/o.

Author: Adams Lau
Reviewer:
Last edited: 17/07/25