Transcript Frequently asked questions in pediatric epilepsy

Frequently Asked
Questions in
Pediatric Epilepsy
Lorraine M. Lazar, MD, PhD
Pediatric Epilepsy
Northeast Regional Epilepsy Group
Individualized answers may differ based on
patient diversity
“My child doesn’t have
epilepsy, right?”

“Epilepsy” = unprovoked seizures due to spontaneous
electrical misfiring in the brain, not due to ‘acute’
(temporary) medical illness or temporary brain irritation

Misperceptions
 NOT synonymous with
 “Cerebral
Palsy”
 “Cognitive
 “Mental
 Fragile
 NOT
Disability”
Retardation”
/ Sickly
uncommon
 326,000
children in the U.S. < 15 years old have
epilepsy
 200,000 new cases diagnosed each year
TreatmentEpileptic
guidedSeizure
by eizure
Classification
(simplified)
PARTIAL
Simple
Absence
GENERALIZED
Complex
Myoclonic
Tonic-Clonic
Tonic
Atonic
“What caused my child’s
epilepsy?”
Multiple Causes of Epilepsy
SYMPTOMATIC
IDIOPATHIC
“Why did the seizures start
now?”
Age Related Onset Of Childhood Epilepsy Syndromes
JME
Juvenile Absence
GTC on awakening
Childhood Absence
Rolandic
Lennox-Gastaut
Febrile Seizures
Benign Myoclonic
Infantile Spasms
Early Epil Encephalopathy
Neonatal seizures
Age (yrs) at Seizure Onset
“Will my child have to take
medication forever?”

~ 65 % of children seizure free on medication for 2 years
will remain seizure free after medication discontinued

If seizures return off medication, they are typically
controlled by restarting medication

Examples of low risk of seizure recurrence off medication:
 Benign
Rolandic
 Childhood

Absence
Examples of high risk of seizure recurrence off medication:
 Lennox-Gastaut
 Juvenile
syndrome
Myoclonic Epilepsy
Factors associated with a higher risk of
seizure relapse if medication is discontinued
Increased seizure recurrence risk if abnormal
neurologic exam or epileptiform EEG
NonEpileptiform
EEG
NonEpileptiform
EEG
Epileptiform
EEG
Epileptiform
EEG
NORMAL
EXAM
ABNORMAL
EXAM
NORMAL
EXAM
ABNORMAL
EXAM
Tonic-Clonic
30 %
51 %
47 %
73 %
Simple Partial
50 %
75 %
71 %
92 %
Complex Partial
58 %
83 %
77 %
96 %
“How do I keep my child
safe?”

Medication Compliance
 Regular doctor’s appointments
 Pill Sorter
 Inform doctor of insurance issues

Avoid seizure triggers
 sleep deprivation
 missing medication (forgetting, running out)
 illness/fever
 excessive alcohol use, illicit drug use
 flashing lights
 stress/anxiety
Know Basic Seizure First Aid (at Home and School):
1. Stay calm
2. Time the seizure
3. Roll onto side
4. Move objects away
5. Don’t restrain
6. Don’t put anything
in the mouth
7. Be reassuring as
seizure stops

Water Safety – minimize drowning hazard
 Bathe
under constant supervision (unlocked bathroom door)
 Consider
 Never
 Wear

shower (with clear drain) over bath
swim alone
life vest in murky water
Sports Safety:
 Always
wear appropriate sports safety gear (helmets a must!)
 Avoid
climbing heights without a harnass
 Avoid
bicycling in open traffic

Travel Safety:
 Avoid sleep deprivation
 Carry medications on trips
 Have enough medication to last the trip
 For older teens, follow DMV laws for driving

Medication Safety:
 Inform your epilepsy doctor of other medications
being taken, whether prescribed or over-the-counter
 Benadryl
– can lower seizure threshhold
“Can my child die from
seizure?”

SUDEP – Sudden Unexpected Death of someone with
Epilepsy, who was otherwise healthy.

Rare in children

More common in adults, especially if seizures uncontrolled

Cause of death in SUDEP unclear
 irregular
heart rhythm?
 suffocation
from impaired breathing, fluid in the lungs,
being face down on bedding?

Best prevention is to follow treatment recommendations,
including take anti-seizure medication regularly
“Should my child see a seizure specialist?”
YES!