Childhood Epilepsy

1. Childhood Epilepsy Stefanie Jean-Baptiste Berry, MD Pediatric Epileptologist Northeast Regional Epilepsy Group

2. 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

3. What is a seizure? • Abnormal and excessive electrical activity of brain cells (neurons) • Seizure types: Generalized Focal (Partial) Focal with secondary generalization

4. 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

5. 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.

6. 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

7. Common EEG abnormalities: 1.) Slowing 2.) Spikes 3.) Seizures

8. Normal

9. Slowing

10. Spikes

11. Spikes

12. Seizure

13. 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

14. 2.) Ketogenic Diet – high fat and protein; low carb 3.) Surgery/Vagal Nerve Stimulator

15. Epilepsy Syndromes • Typical Absence • Juvenile Myoclonic Epilepsy • Benign Epilepsy in Childhood with Centrotemporal Spikes (Rolandic Epilepsy)

16. 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

17. Typical Absence • Most patients with typical absence have normal neurological exams and intelligence scores • Generalized spikes on EEG • Medications: Zarontin, Lamictal, Depakote

18. 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

19. Juvenile Myoclonic Epilepsy • Myoclonic jerks, generalized tonic-clonic 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

20. 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)

21. Benign Rolandic Epilepsy • 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

22. 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

23. 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

24. 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

25. Seizure Safety • 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

26. Seizures Precautions • Avoid heights >4 feet • No baths • Swimming should be supervised • Keep bathroom door unlocked • Teens – no driving X 1 year

27. Other • Good to inform school of child’s condition • May play sports if seizures well controlled • Videogames okay for most

28. Prognosis • 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

29. Prognosis • Injuries common in epilepsy (Generalized tonic-clonic) • Lacerations, Fractures, Burns • SUDEP not very common (2.3 times more than general population)

30. 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

31. 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)

32. 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

33. Resources • www.epilepsygroup.com • www.epilepsyfoundation.org • www.epilepsyadvocate.com • www.paceusa.org • www.epilepsy.com