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

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

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

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

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.

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

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

Normal

Slowing

Spikes

Seizure

Treatment 1.) Medication: Trileptal, Tegretol, Keppra, Depakote, Lamictal and Phenobarbital Choice based on type of seizures, EEG findings, side effects, age and sex 2 nd med may be added if seizures not controlled

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

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

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

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

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

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

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)

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

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

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

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

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

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

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

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

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

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

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)

Increase risk of recurrence if 1 st 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

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