Taming the Wild West of Early Life Epilepsy Care: One Question at a Time

Most early life epilepsies are treated within an “evidence-free practice zone,”¹ and many seizure therapies have seeped into practice without thorough vetting in studies designed under traditional standards for evidence-based medicine. In this issue of Neurology®, Treadwell² and Tsou³ present formal systematic reviews of literature published since 1999 for the effectiveness of and “harm” from antiseizure medications (ASMs) and dietary therapies² and epilepsy surgery³ in children younger than 36 months. Their conclusions echo those of the 2015 International League Against Epilepsy working group that there is little evidence to direct current treatment practices.⁴ This is a tough and worthy topic. We agree with the authors’ conclusions on the main point but differ on others.

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