Epilepsy in children Flashcards
What is Epilepsy?
Epilepsy is an umbrella term for a condition where there is a tendency to have seizures.
What are seizures?
Seizures are transient episodes of abnormal electrical activity in the brain.
Generalized Tonic-Clonic Seizures
There is loss of consciousness and tonic (muscle tensing) and clonic (muscle jerking) movements. Typically the tonic phase comes before the clonic phase.
There may be associated *tongue biting, incontinence, groaning, and irregular breathing.
Post-ictal phase: After the seizure, there is a prolonged post-ictal period where the person is confused, drowsy, and feels irritable or low.
Maintance management of tonic-clonic seizures is with:
- First line: Sodium Valproate
OR
Phenobarbitone (< 6 months old)
- Second line: Lamotrigine
Focal Seizures
Focal seizures start in the temporal lobes. They affect hearing, speech, memory, and emotions. There are various ways that focal seizures can present:
- Hallucinations
- Memory flashbacks
- Déjà vu
- Doing strange things on autopilot
Focal seizures management maintenance:
One way to remember the treatment is that the choice of medication is the reverse of tonic-clonic seizures:
- First line: Carbamazepine
- Second line: Lamotrigine and Topiramate
Absence seizures/ Petitmal
Absence seizures typically happen in children and are sometimes mistaken for daydreaming and inattentiveness.
1. Starring
2. Loss of expression
3. Upward eye movements
4. Unresponsiveness
5. Eye blinking
lasts for 5-10 seconds
Post-ictal period: Person recovers immediately + resumes their previous activity with no memory of seizure.
Absence seizures maintenance management:
- First line: Sodium valproate
2. Second line: Lamotrigine
Atonic seizures?
Atonic seizures are also known as drop attacks. They are characterized by brief lapses in muscle tone. These don’t usually last more than 3 minutes. They typically begin in childhood.
Atonic seizures management:
They may be indicative of Lennox-Gastaut syndrome. Management is:
- First line: sodium valproate
- Second line: lamotrigine
Myoclonic seizures?
Myoclonic seizures present as sudden brief muscle contractions, like a sudden “jump”. The patient usually remains awake during the episode. They occur in various forms of epilepsy but typically happen in children as part of juvenile myoclonic epilepsy.
Myoclonic seizures Maintenance Management is:
- First line: Refer all for specialist investigation and initiation of therapy with Sodium valproate.
DIAGNOSTIC CRITERIA
A child may be diagnosed:
°With a specific anatomical or systemic cause for the seizure type (see table of possible causes);
°As having an epileptic syndrome, i.e. a specific seizure type associated with a characteristic EEG, natural history, response to anticonvulsant therapy and prognosis;
°With cryptogenic epilepsy.
Investigations
° MRI of the brain is the preferred investigation for recurrent seizures in children. If not available, a CT scan of the brain is indicated.
° EEG: is indicated for recurrent or syndromic seizures where a diagnosis cannot be made on clinical grounds alone. Delay an EEG for at least one week after the convulsive episode.
° If atypical, a 12 lead ECG should be considered in diagnostic uncertainty – it is important to consider prolonged QT interval syndromes.
GENERAL AND SUPPORTIVE MEASURES
° Minimise the impact of the epilepsy by obtaining complete seizure control to maximise the child’s full potential.
° Educate the patient and caregiver about epilepsy and associated complications and comorbidities, i.e. learning difficulties and ADHD.
