Taming the Wild West of Early Life Epilepsy Care

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.