SEIZURE DISORDERS ( Pediatrics )

Childhood Epileptic Syndromes Infantile spasms   onset 4-8 months brief, repeated contractions of neck, trunk and extrem...

Childhood Epileptic Syndromes

Infantile spasms

 

1. onset 4-8 months
2. brief, repeated contractions of neck, trunk and extremities (flexion and extension) lasting 10-30 seconds
3. occur in clusters; often association with developmental delay
4. 40% unknown etiology but association with syndromes e.g. tuberous sclerosis
5. treatment includes ACTH, oral steroids, benzodiazepines, valproate, vigabatrin

Lennox-Gastaut

 

1. preschool children
2. multiple seizure types common with frequent status epilepticus
3. seen with previous encephalopathy and brain malformations
4. treatment includes valproic acid, benzodiazepines and ketogenic diet; however, responses often poor

Juvenile myoclonic epilepsy

 

1. adolescent onset (12-16 years of age); autosomal dominant
2. myoclonus particularly in morning (generalized T-C)
3. requires lifelong valproic acid; prognosis excellent

 

Benign childhood epilepsy with rolandic spikes

 

1. onset peaks at 9-10 year of age
2. focal motor seizures involving tongue, mouth and face
3. remains conscious but aphasic post-ictally
4. remits spontaneously in adolescence; no sequellae

 

Generalized Tonic Clonic Seizures

1. most common type of nonfebrile seizures in childhood
2. generalized from onset (does not include partial seizures thatbecome generalized)
3. often associated with tongue biting and incontinence

An Approach to the Child with a Suspected Convulsive Disorder

 

Did the child have a seizure?

NO	YES
Breath holding Night tremor Benign paroxysmal vertigo Cough syndrome Familial choreoathetosis Hereditary chin trembling Narcolopsy Pseudoseizures	Investigation: Electrolytes, BUN, creatinine,Calcium, magnesium, glucose EEG, CSF, CT, ABG Hypoxic ischemic encephalopathy “ashpyxia” Intracranial hemorrhage, trauma eg. shaken baby syndrome Ingestions/drug withdrawal Metabolic causes CNS infections Idiopathic epilepsy Neurocutaneous syndromes Benign febrile seizures Tumour/AV malformation

Treatment

 

1. treat with drug appropriate to clinical situation
2. start with one drug and increase dosage until seizures controlled
3. if no effect, switch over to another before adding a second anticonvulsant
4. education for patient and parents
   • privileges and precautions in daily life (e.g. buddy system)
5. continue anticonvulsant treatment until patient free of seizures for 2 years or more

 

Anticonvulsive Treatment by Seizure Type

 

Seizure Type	Treatment
absence	ethosuximide or valproic acid if > 2 years
generalized tonic-clonic	phenobarbital in first 12 months, carbamazepine after
myoclonic	ethosuximide, valproic acid, primidone, clonazepam
partial seizures	carbamazepine or phenytoin (Gabapentin, Lamotrigine, Vigabatrin as add-on therapy)