Transcript Stefanie Jean-Baptiste Berry, MD. Epilepsy in Children

Childhood Epilepsy
Stefanie Jean-Baptiste Berry, MD
Pediatric Epileptologist
Northeast Regional Epilepsy Group
What is Epilepsy?
• 2 or more unprovoked seizures
• Incidence <10 years old 5.2 to 8.1 per
1,000 (highest <1 year)
• Causes: Brain malformations, birth
injury, infection, tumor & trauma;
69% with unknown cause
What is a seizure?
• Abnormal and excessive electrical
activity of brain cells (neurons)
• Seizure types:
Generalized
Focal (Partial)
Focal with secondary generalization
• Generalized Seizures:
1.) Generalized tonic-clonic (grand
mal)- Unconscious, whole body shaking;
variable duration
2.) Absence (petit mal) – Staring,
unawareness, brief (seconds)
3.) Myoclonic – Brief jerk of arm or leg
4.) Atonic – Sudden drop
• Focal (Partial) Seizures:
1.) Simple – Consciousness preserved;
twitching of one side of face or body,
numbness, visual
2.) Complex – Impaired consciousness;
twitching, head/eye deviation etc.
Testing
• EEG – records brain activity; seizures
or potential for seizures
• Video-EEG – prolonged; overnight in
hospital
• MRI of brain – picture of brain; look
for abnormal structure
• Common EEG abnormalities:
1.) Slowing
2.) Spikes
3.) Seizures
Normal
Slowing
Spikes
Spikes
Seizure
Treatment
1.) Medication:
• Trileptal, Tegretol, Keppra, Depakote,
Lamictal and Phenobarbital
• Choice based on type of seizures, EEG
findings, side effects, age and sex
• 2nd med may be added if seizures not
controlled
2.) Ketogenic Diet – high fat and
protein; low carb
3.) Surgery/Vagal Nerve Stimulator
Epilepsy Syndromes
• Typical Absence
• Juvenile Myoclonic Epilepsy
• Benign Epilepsy in Childhood with
Centrotemporal Spikes (Rolandic
Epilepsy)
Typical Absence
• Generalized seizures
• Sudden discontinuation of activity with
loss of awareness, responsiveness, and
memory, with an abrupt recovery
• Most common in the first decade,
particularly ages 5-7 years of age
Typical Absence
• Most patients with typical absence
have normal neurological exams and
intelligence scores
• Generalized spikes on EEG
• Medications: Zarontin, Lamictal,
Depakote
Typical Absence
• Average age when seizures stop is 10
years old
• Typical absence seizures generally
have a good prognosis – resolves in
approximately 80 percent of cases
Juvenile Myoclonic Epilepsy
• Myoclonic jerks, generalized tonicclonic seizures, and sometimes
absence seizures
• Usual age at onset of absence
seizures is 7 to 13 years; myoclonic
jerks, 12 to 18 years; generalized
tonic-clonic seizures, 13 to 20 years
Juvenile Myoclonic Epilepsy
• More likely to have seizures with sleep
deprivation and alcohol ingestion
• Risk for seizures is lifelong
• Photic stimulation often provokes a
discharge.
• Seizures are usually well-controlled
with medication (Depakote, Lamictal)
Benign Rolandic Epilepsy
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Onset is between 3 and 13 years
Peak age of onset is 7-8 years
Resolves by age 16
Normal intelligence amd neurological
exam
• Seizures usually happen after falling
asleep or before awakening
Benign Rolandic Epilepsy
• One-sided numbness of the face,
one-sided clonic or tonic activity
involving the face, unable to speak,
drooling
• No loss of consciousness
• Can have secondarily generalized
tonic-clonic seizures
Benign Rolandic Epilepsy
• Spikes in midtemporal and central
head region
• More spikes in drowsiness and sleep
and 30% of cases show spikes only
during sleep
Benign Rolandic Epilepsy
• No treatment is necessary in
patients with infrequent, nocturnal,
partial seizures
• If seizures are frequent and/or
disturbing to patient and family,
treatment with Tegretol or Trileptal
• Good prognosis
Seizure Safety
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Lay child on floor on his/her side
Do not restrain
Nothing in the mouth
Diastat (rectal valium)
Call ambulance
May be confused or sleepy after
Seizures Precautions
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Avoid heights >4 feet
No baths
Swimming should be supervised
Keep bathroom door unlocked
Teens – no driving X 1 year
Other
• Good to inform school of child’s
condition
• May play sports if seizures well
controlled
• Videogames okay for most
Prognosis
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Depends on seizure type
Usually treat at lest 2 years
Absence – 80% resolve
JME- respond well to treatment but
need meds for life
• Neurologically abnormal often
difficult to control seizures
Prognosis
• Injuries common in epilepsy
(Generalized tonic-clonic)
• Lacerations, Fractures, Burns
• SUDEP not very common (2.3 times
more than general population)
Febrile Seizures
• Not epilepsy
• Often a family history
• Seizures only occur with fever in
children age 6 months – 6 years
• Up to 4% of children
• Simple – 1 brief seizure (genralized)
• Complex – prolonged; more than 1;
focal
• Developmental delay or family history
of epilepsy – more develop epilepsy
• 1/3 have second (1/2 of that third
have third)
• Increase risk of recurrence if 1st
before 18 months or lower temperature
• Increase risk of epilepsy if >3 febrile
• Testing unnecessary with simple
• Focal need MRI
• EEG in high risk
• Treatment usually not necessary
Resources
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www.epilepsygroup.com
www.epilepsyfoundation.org
www.epilepsyadvocate.com
www.paceusa.org
www.epilepsy.com