New epilepsy treatment in children: upcoming strategies and rewind to ancient times and concepts

Abstract The epilepsies are the most common chronic neurological disorders in children. Considerable steps towards a better understanding of different aspects of the once considered ‘sacred disease’ have been made over the last two centuries, culminating in the development of new pharmacological and alternative antiepileptic treatments. However, principles of antiepileptic drug therapies have changed little since their breakthrough in the 20th century and the emphasis still lies on treating the symptom by enhancing inhibitory currents and suppressing excitatory networks rather than on addressing underlying neurobiological mechanisms. Around one third of the patients do not respond to the currently available drugs. New therapeutic strategies are on the horizon comprising inflammatory, immune and intracellular pathway targeting, as well as neuromodulation and novel surgical and dietary interventions. Furthermore, the prospect of personalized treatment for epilepsy using epigenetic and genetic techniques is becoming a reality. We discuss current and new concepts and future possibilities in the effort to cure the epilepsies.