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Teresita Y. Nelson, MD

Management of Pediatric Epilepsy. Teresita Y. Nelson, MD. Evaluation of a Patient with Seizures:. Other Episodic Phenomena. Tourette syndrome Paroxysmal kinesogenic choreoathetosis Paroxysmal dystonic choreoathetosis G.E. Reflux (Sandifer syndrome) Factitious seizures

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Teresita Y. Nelson, MD

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  1. Management of Pediatric Epilepsy Teresita Y. Nelson, MD

  2. Evaluation of a Patient with Seizures: Other Episodic Phenomena • Tourette syndrome • Paroxysmal kinesogenic choreoathetosis • Paroxysmal dystonic choreoathetosis • G.E. Reflux (Sandifer syndrome) • Factitious seizures • Munchausen syndrome • Munchausen by proxy • Periodic Paralysis

  3. Management of Pediatric Epilepsy • Medication • 1st Line • 2nd Line • Surgery • VNS • Resection • Callosotomy • Ketogenic Diet

  4. AED Mechanisms • Decrease Excitation Na +, Ca ++, EAA, K + • Promote Inhibition GABA, Cl – • Other Serotonin, Synaptic Vesicle Protein

  5. Voltage activated Na+ channel blockade PHT, CBZ, VPA, FBM, LTG, TPM, ZNS Voltage Activated Ca++ currents decrease TPM, LEV Carbonic anhydrase inhibition Acet, TPM, ZNS Reduction of T- Ca++ Currents ESM, VPA, ZNS Enhancement of GABAA mediated Cl- currents Barbs, BZPs, TPM, ~VGB, ~TGB, VPA, LEV, GBP Modulation of Excitatory Amino Acids FBM, TPM, LEV AED Mechanisms

  6. Double-blind, placebo-controlled trials in pediatric epilepsy involving new AEDs

  7. Double-blind comparative trials of pediatric epilepsy involving new AEDs

  8. 50% response rate in double-blind, placebo controlled adjunctive therapy pediatric partial seizure trials involving new AEDs * ≥ 50% reduction in seizure frequency.

  9. Seizure freedom during open-label extension phase of double-blind, placebo-controlled trials of pediatric epilepsy involving new AEDs

  10. Dosing Pre-1993

  11. Dosing Post-1993

  12. EEG: 3yo Child Receiving CBZ and VPA Guerrini R et al. Epilepsia 39(Suppl3):56, 1998

  13. CBZ Withdrawn: One Month Later Guerrini R et al. Epilepsia 39(Suppl3):56, 1998

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