2210 SECTION 29: Disorders of the Nervous System

Table 562-1. Antiepileptic Drug (AED) Formulations and Dosages in Children

AED Initial Dose Maintenance Dose Divided Formulation
Phenobarbital 5 mg/kg/day Same Once or twice daily Suspension: 20 mg/5 mL
Phenytoin 4 to 5 mg/kg/day 4 to 8 mg/kg/day Two or three times daily Tablets: 15,30, 60 mg
Suspension: 125 mg/5 mL
Tablets: 50 mg
Capsules: 30, 100 mg
Ethosuximide 250 to 500 mg/day 15 to 20 mg/kg/day Two or three times daily Solution: 250 mg/5 mL
Capsules: 250 mg
Carbamazepine 5 to 10 mg/kg/day 15 to 20 mg/kg/day Two or three times daily Suspension: 100 mg/5 mL
Tablets: 100, 200 mg
Valproic acid 10 to 15 mg/kg/day 15 to 30 mg/kg/day Two or three times daily Syrup: 250 mg/5 mL
Sprinkles: 125 mg
Tablets: 125, 250, 500 mg
Capsules: 250 mg
Diazepam 2 to 5 yrs: 1.5 mg/kg/day Same Three times daily Solution: 5 mg/5 mL
6 to 11 yrs: 0.9 mg/kg/day Same Tablets: 2, 5, 10 mg
Lorazepam 0.05 to 0.2 mg/kg per dose Same N/A Solution: 2 mg/mL
Clonazepam 0.01 mg/kg/day 0.1 mg/kg/day Three times daily Suspension: 0.1 mg/1 mL
Max: 0.1 mg/kg/day Tablets: 0.5, 1, 2 mg
Clobazam 0.25 mg/kg/day 1 mg/kg/day Tablets: 10 mg
Felbamate 15 mg/kg/day 15 to 45 mg/kg/day Two or three times daily Suspension: 600 mg/5 mL
Tablets: 400, 600 mg
Gabapentin 10 to 15 mg/kg/day 30 to 100 mg/kg/day Three times or twice Solution: 250 mg/5 mL tab.: 600, 800 mg
daily capsules: 100, 300, 400 mg
Lamotrigine Twice daily Tablets: 25 , 100, 150, and 200 mg. Chewable
(See Table 562-3) tablets: 2, 5, and 25 mg
Topiramate 0.5 to 1 mg/kg/day 4 to 8 mg/kg/day Twice daily Sprinkles: 15, 25 mg tablets: 25, 100, 200 mg
Tiagabine 0.1 mg/kg/day 0.6 to 1.0 mg/kg/day Two or three times daily Tablets: 2, 4, 12, 16, 20 mg
Vigabatrin 40 mg/kg 80 to 100 mg/kg/day (150 mg/ Twice daily Powder sachet: 500 mg
kg/day for infantile spasms) Tablets: 500 mg
Levetiracetam 10 mg/kg/day 40 to 60 mg/day Twice daily Solution: 100 mg/mL
Tablets: 250, 500, 750 mg
Oxcarbazepine 5 to 10 mg/kg/day 20 to 30 mg/kg/day Twice daily Suspension 300 mg/5 mL
Tablets: 150, 300, 600 mg
Zonisamide 1 to 2 mg/kg/day 4 to 8 mg/kg/day Once or twicedaily Capsules: 25, 50, 100 mg
Max: 12 mg/kg/day
Pregabalin 3.5 to 5 mg/kg/day 15 to 20 mg/kg/day Twice daily Capsules: 25, 50, 75, 100, 150, 200, 225, 300 mg

Reproduced with permission from Hadjiloizou SM, Bourgeois BFD. Antiepileptic drug treatment in children. Expert Rev Neurotherapeutics. 2007;7:179-193.

would be valproic acid (VPA), lamotrigine
(LTG), levetiracetam (LEV), or topiramate
(TPM) because of the available evidence. Carba-
mazepine (CBZ), phenytoin (PHT), or zonisam-
ide (ZNS), which are potentially effective, could
be considered as further choices, but CBZ and
PHT should be avoided if an idiopathic general-
ized epilepsy is suspected.
■ ABSENCE EPILEPSIES: CHILDHOOD
AND JUVENILE ABSENCE EPILEPSY
(CAE AND JAE)
Children with absence seizures may be divided
into 2 age categories: those under the age of 10
years and those above the age of 10 years.
There are at least 3 reasons for this: (1) con-
comitant GTCS are more likely to occur after
the age of 10 years in patients diagnosed with
CAE, and are common in JAE; (2) the inci-
dence of VPA-induced fatal hepatotoxicity is
highest in infants and young children, espe-
cially in combination therapy; and (3) the in-
cidence of severe hypersensitivity reaction
associated with LTG also appears to be in-
versely age related. Consequently, Ethosuxi-
mide (ESM) may still represent the drug of
first choice in patients younger than 10 years
old who have only absence seizures, as is usu-
ally the case in CAE. In any child older than 10
years with absence seizures, when an AED
needs to be introduced or changed, the choice
would be valproic acid (VPA). It is quite safe
in monotherapy at this age and highly effective
against GTCS, whereas ESM offers no such
protection. LTG, which is also effective against
absence seizures and GTCS, is quite safe in this
age group and is a valuable alternative to VPA,
especially in adolescent girls.
■ JUVENILE MYOCLONIC
EPILEPSY (JME)
Valproic acid (VPA) remains a drug of choice
for JME. However, the side-effect profile of