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Review management of childhood epilepsy Partial epilepsy

Epilepsy Epilepsy is the name for occasional sudden, excessive, rapid and local discharges of grey matter(Hughline Jackson 1873) Excessive synchronous firing of an aggregated neurons Epileptic syndrome Epileptic syndrome is a a chronic condition characterised by recurrent seizures, cluster of symptoms and signs that occur together. Seizures Abnormal behaviour resulting from abnormal discharges of cortical neurons.

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Review management of childhood epilepsy Partial epilepsy

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    1. Review management of childhood epilepsy( Partial epilepsy)

    2. Epilepsy Epilepsy is the name for occasional sudden, excessive, rapid and local discharges of grey matter(Hughline Jackson 1873) Excessive synchronous firing of an aggregated neurons Epileptic syndrome Epileptic syndrome is a a chronic condition characterised by recurrent seizures, cluster of symptoms and signs that occur together. Seizures Abnormal behaviour resulting from abnormal discharges of cortical neurons

    3. Epilepsy Incidence of epilepsy is 20-50 new cases per 100.000 population per year Fifty million people world wide suffer from epilepsy About 60% of epileptic patients have additional neurological or neuropsychological problem

    4. CLASSIFICATION OF SEIZURES Partial A-Simple B Complex (Evolving to generalised) Motor Impaired consciousness Sensory at onset Autonomic Simple onset-> impaired consciousness Psychic Generalised Tonic/Clonic Absence Myoclonic Clonic Atonic Unclassified

    5. Classification of epilepsy Generalised epilepsies 1-Idiopathic (with age onset) Benign neonatal familial convulsions Benign neonatal convulsion Benign Myoclonic epilepsy in infancy Childhood absence epilepsy Juvenile absence epilepsy Juvenile Myoclonic epilepsy Generalised tonic-Clonic seizures on awakening Other generalised idiopathic epilepsies not mentioned above Epilepsies with seizures precipitated by specific modes of activation e.g. reading reflex

    6. 2- Cryptogenic or symptomatic generalised epilepsies and syndromes West,s syndrome Lennox Gastaut syndrome Epilepsy with Myoclonic astatic seizures Epilepsy with Myoclonic absences symptomatic Non specific aetiology Early Myoclonic encephalopathy Early infantile epileptic encephalopathy with burst suppression Other symptomatic generalised epilepsies not defined above Specific syndromes/aetiological Cerebral malformation Inborn error of metabolism

    7. 2-Localisation-related (local,local, partial) epilepsies syndrome 1-Idiopathic (with age related) Benign childhood epilepsy with centro-temporal spikes Childhood epilepsy with occipital paroxysms Primary reading epilepsy 2-Symptomatic Chronic progressive epilepsia partialis continua of childhood Seizures characterised by specific modes of perception Other epilepsies and syndromes based in localization or aetiology Cryptogenic

    8. Investigations EEG Awake and sleep EEG Video telemetry EEG Ambulatory EEG Magnetic EEG Corticography EEG Amytal test Neuroimaging MRI (epilepsy protocol) SPECT (Ictal and Interictal) PET

    9. Benign childhood epilepsy with centro-temporal spikes Common syndrome of Idiopathic partial epilepsy in childhood 15-25% of school-age children with epilepsy Genetically determined (AS or AD ?) Onest between 2-13 years (mean 7 year) Simple partial seizures,motor,buccal or labial paraesthesia. Involve mainly face with salivation and /or speech arrest Last 30-60 seconds 60-80% occur during sleep Secondary generalised seizure occur in 20% Sleep EEG (Midtemporal or lower rolandic area) No neuroimaging Treatment ?

    10. Childhood epilepsy with occipital paroxysms Onest 4-9 years 1st syndrome: Simple partial seizures with visual symptoms (transient loss of vision, or visual hallucination of colours or geometric shapes) Post-ictal migraines headache in 30% EEG Continuous, rhythmical spike-wave activity which arrested or lessened by eye-opening(fixation phenomenon) 2nd syndrome: Nocturnal seizures,ictal vomiting, persistent eye deviation and loss of consciousness May last for hours in 50% It is not benign as 1st syndrome Carbamazepine Neuroimaging?

    11. Temporal lobe epilepsy Is the most common cause of complex partial seizures Preceded by Aura ( hallucination and illusion, epigastric sensation in young children with fear, head deviation and posturing in < 2 year of age Start as staring or behaviour arrest Automatism (lip smacking, licking,chewing or swallowing movements Fingering or fumbling with cloths are also frequent Tonic posturing and head rotation are often in age group of <2 years Last 1-2 minutes and followed by confusion or /and intense tiredness In older children and adolescents, mesial temporal lobe epilepsy

    12. Mesial temporal lobe epilepsy Atrophy and gliosis of the hippocampus and often the amygdale Long unilateral febrile seizures in 40-60% Partial seizures start in the 1st 10 years of life Seizure marked by behavioural arrest, starring, automatism (facial), dystonic posturing of the arm contralateral to the discharging temporal lobe while automatism ipsilateral arm EEG: Interictal anterior temporal spike focus or some times a paroxysmal theta rhythm. Ictal will show diffuse discharge other side MRI PET SECT Outcome after surgery is very good Cortical dysplasia in temporal lobe have favourable surgical outcome.

    13. MRI(Cortical dysplasia)

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