11 Epilepsy in Children Steinberg Flashcards
What is the difference in race and seizure disorder?
Whites have highest prevalence
What medical comorbidities are more likely to be found in patients with childhood epilepsy?
Depression. Anxiety. ADHD. Conduct problems. Developmental delay. Autism/autism spectrum disorder. HAs. Hearing or vision problems. Asthma. Allergies. Ear infections
What is the problem with treating children after their first unprovoked seizure?
You would over treat ~60% of children since they often do not have a recurrence
Why type of children have a higher recurrence rate for seizures?
Children with remote symptomatology (e.g. prior CNS infection, vascular insult, etc) or abnormal interictal EEG
What is seizure recurrence rate like by EEG results?
Children with a normal EEG had a much lower risk of recurrence. Nonepileptiform EEG had higher recurrence, but Epileptiform EEG had the highest recurrence rates
How often does it usually take for a recurrence to occur?
First recurrence usually occurs in the next 6 months
What drugs are First-Line for Epilepsy with generalized Tonic-Clonic Seizures?
Oxcarbazepine*, Carbamazepine, Lamotrigine, Sodium Valproate
What drugs are First-Line for Childhood and Juvenile Absence Seizures?
Lamotrigine, Ethosuximide. Valproic Acid
What drugs are First-Line for Myoclonic Seizures?
Lamotrigine, Levetiracetam, Topiramate*, Valproic acid
What drugs are First-Line for Idiopathic Generalized Epilepsy?
Lamotrigine, Topiramate, Valproic Acid
What did the SANAD Study Group show in the comparison of AEDs for Partial Epilepsy?
Non-inferiority of LTG compared with CBZ. These two were better than others though
For Childhood Epilepsy, what are Benign Epilepsies?
20-30%. Remission occurs after a few years and treatment can often be avoided
For Childhood Epilepsy, what are Pharmacosensitive Epilepsies?
30%. Seizure control easily achieved by AEDs, spontaneous remission occurs after a few years (e.g. childhood absence)
For Childhood Epilepsy, what are Pharmacodependent Epilepsies?
20%. Drug treatment controls seizure, but no spontaneous remission occurs (e.g. juvenile myclonic epilepsy, symptomatic focal epilepsy); drug withdrawal is followed by relapse and treatment will be lifelong
For Childhood Epilepsy, what are Pharmacoresistant (or refractory) Epilepsies?
13-17%. Poor prognosis; resistance to drugs can usually be predicted early after an inadequate response to initial appropriate treatment
What happens if a patient fails remission and goes into relapse?
Doesn’t mean its over, patients can often go back into remission
What factors cause a child to be associated with decreased risk of relapse?
Log initial seizure frequency. Idiopathic partial epilepsy. Onset < 1 year old. Never taken AEDs
What factors cause a child to be associated with increased risk of relapse?
Juvenile myoclonic epilepsy. Focal slowing on initial EEG
Why do Topiramate concentrations in pediatrics differ?
Higher clearance in younger pediatric patients, concentration increases with age. Need higher doses in younger children to get the same % Fraction Seizure Free
What are the characteristics of “Typical” Absence Seizure?
ABRUPT onset in childhood. Totaly lost consciousness. Short duration of seizure (usually < 10 sec), numerous and frequently in clusters. Caused by Idiopathic generalized epilepsy. Usually normal interictal EEG appearance
What are the characteristics of “Atypical” Absence Seizure?
Often gradual onset of any age. Only partially impaired consciousness. Long duration (several minutes) and less frequent. Confusion, HA, emotional disturbance are common. Usually these patients have learning difficulties. Abnormal interictal EEG appearance
When comparing Ethosuximide, Valproic Acid, and Lamotrigine on a graph, what happens to their Freedom from Treatment Failure?
They’re all relatively the same, but after ~16 weeks, Lamotrigine rapidly drops. Lamotrigine has a high lack of seizure control compared to the others (efficacy of LTG is the problem, not the ADRs or other drug profiles)
What is Lennox-Gastaut Syndrome (LGS)?
One of the Epileptic encephalopathies (conditions where epileptiform abnormalities themselves contribute to a progressive disturbance in cerebral function)
What is LGS characterized by?
1) Multiple generalized seizure types, typically tonic, atonic and myoclonic, and atypical absence. 2) An interictal EEG pattern characterized by diffuse slow spike-and-wave complexes during sleep and wakefullness. 3) Cognitive dysfunction; develops in most but not all patients
