The latest advances in the pharmacological management of focal epilepsies in children: a narrative review.

Focal epilepsy constitutes the most common epilepsy in children, and medical treatment represents the first-line option therapy in this condition. The main goal of medical treatment for children and adolescents with epilepsy is the achievement of seizure freedom or, in drug-resistant epilepsies, a significant seizure reduction, both minimizing antiseizure medications (ASM)-related adverse events, thus improving the patient's quality of life. However, up to 20-40% of pediatric epilepsies are refractory to drug treatments. In this regard, new ASMs came to light in the pediatric landscape, trying to improve the drug profile compared to that of the preexisting ones. Clinicians should consider several factors during the drug choice process, including patient and medication specific characteristics. This narrative review aims to summarize the latest evidence on the effectiveness and tolerability of the newest ASMs administered as monotherapy or adjunctive therapy in pediatric epilepsies with focal onset seizures, providing a practical appraisal based on the existing evidence. The latest ASMs have the potential to be effective in the pharmacological management of focal onset seizures in children, and treatment choice should consider several drug- and epilepsy-related factors. Future treatments should be increasingly personalized and targeted on patient-specific pathways. Future research should focus not only on discovering new chemical compounds but also on repurposing medications used for other indications.