Review management of childhood epilepsy Partial epilepsy

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Review management of childhood epilepsy( Partial
epilepsy)
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• EpilepsyEpilepsy is the name for occasional
  sudden, excessive, rapid and local discharges of
  grey matter(Hughline Jackson 1873)Excessive
  synchronous firing of an aggregated
  neuronsEpileptic syndrome Epileptic syndrome
  is a a chronic condition characterised by
  recurrent seizures, cluster of symptoms and signs
  that occur together.SeizuresAbnormal behaviour
  resulting from abnormal discharges of cortical
  neurons

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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

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CLASSIFICATION OF SEIZURES

• Partial
• A-Simple B Complex (Evolving to
  generalised)
• Motor Impaired consciousness
• Sensory at onset
• Autonomic
• Simple onset-gt impaired consciousness
• Psychic
• Generalised
• Tonic/Clonic
• Absence
• Myoclonic
• Clonic
• Atonic
• Unclassified

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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

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• 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

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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

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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

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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 ?

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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?

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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 lt 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 lt2 years
• Last 1-2 minutes and followed by confusion or
  /and intense tiredness
• In older children and adolescents, mesial
  temporal lobe epilepsy

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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.

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MRI(Cortical dysplasia)
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