Epilepsy in childhood-indroduction

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Epilepsy in childhood-indroduction

• Epilepsy.
• Convulsion.
• Seizure.
• Fit.
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Epilepsy in childhood-indroduction

• Very common .
• Approx 1 .
• From first minute until last minute.
• A result of abnormal electrical activity of the
  brain ( cortex) .
• which cause acute change in function.
• Usually of motor nature.

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Epilepsy in childhood-indroduction

• Epileptic episode.
• Epileptic disorder ( disease).
• Diagnosis is a clinical one.
• History,sometimes with hysteria
• Observation ( duration ,LOC and
• Description of the motor phenomena)

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Epilepsy in childhood-indroduction

• Clinical presentation
• Motor ( 80-90)
• Sensory.(skin, vision, hearing, taste, smell)
• Behavioral .
• Autonomic.

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Epilepsy in childhood-indroduction

• Neurophysiologic basis.
• Neuron, dendrites, axon.
• Action potentials.
• Synaptic neurotransmitors
• Excitators (glutamic , aspartic ac)
• Inhibitors (GABA )

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Epilepsy in childhood-indroduction

• Classification of epilepsy
• Nature of episode.
• Origin.
• Electrical Abnormality.
• Name of Physician who describe

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Epilepsy in childhood-indroduction

• Current classification of epilepsy since 1989
• Partial ( focal ).
• Generalized .
• Partial with generalization
• Status Epilepctus .

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Epilepsy in childhood-indroduction

• Clinical description of motor seizures
• Clonic.
• Myoclonic.
• Tonic
• Atonic ( Akinetic).

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Epilepsy in childhood-indroduction

• Epileptic episode may include
• Aura.
• Ictal phase ( ictus).
• Post ictal phase.

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Epilepsy in childhood-indroduction

• Epileptic episode may be primary or secondary due
  to
• Primary genetic or idiopathic.

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Epilepsy in childhood-indroduction

• Secondary epileptic episode
• C.N.S malformations
• Metabolic.( metabolic , primary )
• Infectious.
• S.O.L.
• Trauma
• Toxic ( medications, abuse)

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Epilepsy in childhood-indroduction

• Clinical Approach to a child with
• first seizure
• In the E.R.
• Treatment , stabilization.
• Physical /neuro examination.
• Work -up

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Epilepsy in childhood-indroduction

• Observation ( patient , watch ).
• Position , Oxygen mask.
• I.V. line. (other 3 options )
• Medications ( Benzodiazepines-
• Diazepam , midazolam)

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Epilepsy in childhood-indroduction

• Heart rate , BP.
• Temperature ( c.n.s inf vs febrile seizures )
• Dex .
• Physical exam.( trauma, signs of recent
  epileptic episode tonge biting,urine
  incontinence

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Epilepsy in childhood-indroduction

• Neurological Examination
• Usually not helpful.
• State of conciseness.
• Cranial nerves ( eye position)
• Muscle tone.
• Reflexes.
• Sensory response.
• Influenced by ictus type, meds

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Epilepsy in childhood-indroduction

• Medical History
• Past family ( epilepsy )
• child. ( preg , delivery
• p.m.h. , medications,f.s
• Development.
• Present Detailed description
• before episode
• (illness, trauma , meds
• activity , sleep )

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Epilepsy in childhood-indroduction

• Medical History
• Majority of dx are based on hx.
• Not always accurate and reliable
• Sometimes young , old observer.
• Single episode is not an epilepsy
• Usually ( exceptions C.P, T.S, N.F )

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Epilepsy in childhood-indroduction

• Work up in the E.R.
• Two major urgent decisions
• Neuroimaging.
• Spinal tap. (open nl fontanella or Neroim. )
  

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Epilepsy in childhood-indroduction

• Neuroimaging
• C.N.S bleeding .
• S.O.L.
• Acute hydrocephalus.
• L.P
• C.N.S. infection ( bac, viral others )

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Epidural Hemorrhage in ITP
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Epidural Hemorrhage in ITP
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Space Occupying Lesion
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Epilepsy in childhood-indroduction

• Hospitalization
• Observation (recurrent seizure).
• Diagnostic evaluation.
• Parental care and explanations .

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Epilepsy in childhood-indroduction

• Diagnostic Workup during
• Hospitalization
• EEG.
• Neuroimaging.
• Others.

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Epilepsy in childhood-indroduction

• E.E.G.
• Recording of electrical activity of brain.
• Non invasive.
• Cheap.
• Available.
• Portable , bedside, ( picu, nicu).

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Epilepsy in childhood-indroduction

• E.E.G.
• Complete study includes
• Alert.
• Sleep, drowsy.(Sleep deprived)
• Photic stimulation.
• Hyperventilation.

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Epilepsy in childhood-indroduction

• E.E.G.
• Regular study.
• 24h ambulatory study
• Video EEG Study.

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Epilepsy in childhood-indroduction

• E.E.G recording includes
• Background activity.( alert, sleep, CNS diseases,
  drugs)
• Abnormal overidding activity.
• Spike , poly spike , slow wave
• Variable complexes

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Epilepsy in childhood-indroduction

• Abnormal E.E.G is not required for the diagnosis
  of Epilepsy.
• A rule with several exceptions.
• The diagnosis of Epilepsy is a
• Clinical one based on hx and or
• Observation.

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Epilepsy in childhood-indroduction

• 2 Exceptions
• Infantile spasms (West synd)
• Simple Absence Seizure.

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Epilepsy in childhood-indroduction
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Simple Absence Epilepsy
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Epilepsy in childhood-indroduction

• Abnormal EEG could be seen in
• CNS infection.
• Head trauma.
• S.O.L.
• Toxic metabolic conditions.
• Headache , Migraine.
• ADHD , LD.

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Epilepsy in childhood-indroduction

• Are all epileptic episodes required neuroimaging
  ?
• Neuroimaging Modalities
• Ultrasound.
• CT Scan.
• MRI.
• SPECT
• PET

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Epilepsy in childhood-indroduction

• Ultrasound of brain.
• Non invasive.( no radiation)
• Cheap and available.
• Portable
• No need for sedation

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Epilepsy in childhood-indroduction

• CT Scan.
• Relatively cheap.
• Available.
• Radiation.
• Sedation.

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Epilepsy in childhood-indroduction

• MRI.
• Expensive.
• Non available.
• Sedation.
• No radiation
• fMRI

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Epilepsy in childhood-indroduction

• The study of choice in the
• work up of a child with
• Epilepsy is MRI.
• In cases of Emergency in
• ER , CT Scan is
• reliable tool

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Epilepsy in childhood-indroduction

• SPECT ( single photon
• emission computed tomography)
• Epileptic focus.
• Focal blood perfusion.
• Not available.
• Only after epileptic episode.

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Epilepsy in childhood-indroduction

• PET ( position emission tomography)
• Demonstrate the content of 02
• And glucose .
• Epileptic hypermetabolic focus.
• Expencsive.
• Non available.

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Epilepsy in childhood-indroduction

• Epileptic Syndromes
• Age/sex.
• Common clinical expression.
• Common frequency and duration
• Family history /genetic .
• Similar EEG abnormalities.
• Common natural hx and outcome.

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Epilepsy in childhood-indroduction

• Treatment of Epilepsy.
• -Anti epileptic medications.
• -Other medications( steroids , vitamines (B
  complex), diamox)
• -IV IG.
• -Ketogenic diet.
• -VNS.
• -Epileptic surgery.

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Epilepsy in childhood-indroduction

• Treatment of Epilepsy.
• How to select an anti epileptic drug?
• Type of seizure/ syndrome.
• Medical history ( liver , kidney )
• Allergies.
• Side effects.

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Epilepsy in childhood-indroduction

• Treatment of Epilepsy.
• Duration of treatment.
• Side effects.
• Follow up (clinical , laboratory)
• Drug levels.
• Recurrent seizures.
• Compliance.

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Epilepsy in childhood-indroduction

• Outcome
• Type of epileptic syndrome.
• Response to treatment.
• High rate of cure .
• Driving Liecence.
• Army service.