Epilepsy in children Flashcards
Define epilepsy.
Two or more seizures unprovoked by an immediately identifiable cause.
How does the International League Against Epilepsy (ILAE) classify seizures?
By localisation (in which part of the brain the epileptic activity starts) and aetiology.
What are the different classifications for seizures?
Generalised: Large part of cortex is involved, consciousness in impaired
Localised (focal, local, partial): Begins in a focal area of the cerebral cortex
Symptomatic epilepsy: Cause is known
Cryptogenic epilepsy: Presumed to be symptomatic but the etiology is not known
Idiopathic epilepsy: No apparent cause
Explain the pathophysiology of epilepsy.
Imbalance between excitatory and inhibitory neurotransmission resulting in high-frequency burst activity seen as spike and wave on EEG. Seizure propagates if sufficient surrounding neurons are recruited.
What are risk factors and associations with epilepsy?
Idiopathic: Many have +ve FH
Symptomatic: Head trauma, encephalitis, meningitis, CNS tumours, hypoxic-ischaemic injury, intrauterine infections, cerebral dysgenesis
Associations: Non-epileptiform attack disorder (AKA. pseudo-seizures)
Summarise the epidemiology of epilepsy.
1% of children suffer from epilepsy
What are the symptoms of an absence seizure?
Onset 4-12y.
Short episodes (<30s) during which the child stares or blinks, with no apparent awareness of the surrounding.
No aura or postictal phase.
May present as ‘day dreaming’ in class + reduced performance in school.
Usually undergo spontaneous remission during adolescence.
What are the symptoms of a myoclonic seizure?
Sudden brief muscle contractions; often cluster within a few minutes.
If they evolve into rhythmic jerking movements, they are classified as a clonic seizure.
What are the symptoms of an atonic seizure?
Consist of brief loss of postural tone, often resulting in falls and injuries. This seizure type occurs in people with significant neurological abnormalities.
What are the symptoms of a clonic seizure?
Rhythmic, jerking movements
What are the symptoms of a tonic seizure?
Sudden-onset tonic extension or flexion of the head, trunk and/or extremities for several seconds.
What are the symptoms of a generalised tonic-clonic seizure?
Tonic extension lasting for a few seconds followed by clonic rhythmic movements and a prolonged postictal phase.
Often associated with tongue biting, urinary or faecal incontinence.
What are the symptoms of status epilepticus?
A generalised convulsion lasting > 30 minutes or repeated convulsions occurring over 30 minutes without recovery of consciousness between each convulsion.
What are the symptoms of a simple partial seizure?
Seizure with preservation of consciousness; includes sensory, motor, autonomic and psychic experiences. Tonic or clonic movements are initially localised but may move to different parts of the body if the seizure is propagated.
What are the symptoms of a complex partial seizure?
Similar to simple partial seizure but consciousness is impaired and the episode is followed by postictal phase.
What are symptoms of a partial seizure with secondary generalisation?
Focal seizure is followed by GTCS.
What are symptoms of Lennox-Gastaut syndrome?
Affects children aged 1-3 years. Characterised by multiple seizure types (tonix-axial, atonic and absence seizures), developmental regression and learning disability. Often chronic epilepsy resistant to therapy.
What are symptoms of benign childhood epilepsy with centrotemporal spike?
Affects children aged 4-10 years. Clonic seizures affecting face and upper limbs usually during sleep; may progress to GTCS. Also known as benign Rolandic epilepsy. Usually undergo spontaneous remission during adolescence.
What are symptoms of juvenile myoclonic epilepsy?
Affects adolescents; idiopathic generalised epileptic syndrome characterised by myoclonic jerks, GTCS and sometimes absence seizures, usually on awakening. Usually require lifelong treatment but not associated with intellectual impairment.
What are appropriate investigations for epilepsy?
General and neurological examination must be performed to rule out specific aetiologies and focal neurological signs.
EEG: Epileptiform spike and wave activity correlates with different forms of epilepsy (hypsarrhythmia in infantile spasms)
MRI: To rule out underlying pathology, e.g. glial tumour
Lumbar puncture: If infective cause suspected ECG/ECHO/lying/standing
BP: To exclude other causes of fit, faints and funny turns
What is the management for epilepsy?
Education: Explain nature of epilepsy to parent + child. Aim is to give child the most confidence + independence possible. Avoid precipitating factors such as alcohol, sleep deprivation, drugs. Supervision when in pools or baths. Info on driving + insurance. Advice on sudden unexpected death in epilepsy (SUDEP). SEs of AED (e.g. teratogenicity of sodium valproate).
Follow-up: All children with epilepsy should have structured review at least yearly.
Acute Tx of seizure: Long-term antiepileptic medication
What anti-epileptic medication can be used for generalised epilepsy?
Absence seizures: Ethosuximide, Sodium valproate
Myoclonic: Sodium valproate, lamotrigine, topiramate, levetiracetam (adjunct).
Tonic-clonic: Sodium valproate (first-line), topiramate, lamotrigine, levetiracetam (adjunct).
What anti-epileptic medication can be used for partial epilepsy?
Carbamazepine (first-line), topiramate, lamotrigine, gabapentin.
What anti-epileptic medication can be used for epilepsy syndromes?
Infantile spasms: ACTH, prednisolone, vigabatrin.
Lennox–Gastaut syndrome: Lamotrigine, topiramate, vigabatrin.
Benign childhood epilepsy with centrotemporal spike: Carbamazepine (problematic or daytime seizures only).
Juvenile myoclonic epilepsy: Sodium valproate.
When may the ketogenic diet be considered for children with epilepsy?
Children with drug-resistant epilepsy
What are complications associated with epilepsy?
Developmental delay
Poor school performance
SUDEP (500 deaths/year)
What is the prognosis of epilepsy?
Remission depends predominantly on the type of epilepsy.
Patients with epilepsy have a mortality rate 2–3 x that of the general population.
