Epilepsies of childhood-pt2

epilepsy syndromes
1. West syndrome
  1. age
    1. 4-6 months
  2. seizure pattern
    1. violent flexor spasms of the head, trunk & limbs fb extension of the arms
      1. flexor spasms last 1-2 secs
      2. multiple bursts of 20-30 spasms
        often on waking
        but occur many time a day
    2. may be misinterpreted as colic
    3. social interaction often deteriorates
      1. - a useful marker in the hx
  3. causes
    1. neurological
      1. 2/3rds
      2. EEG shows hypsarrhytmia (chaotic pattern of high-voltage slow waves, & multi-focal sharp wave discharges
  4. Rx
    1. vigabatrin
    2. corticosteroids
  5. prognosis
    1. most will subseq lose skills and develop LD or epilepsy
2. Lennox-Gastaut syndrome
  1. age
    1. 1-3 years
  2. seizure pattern
    1. multiple seizure types
      1. mostly drop attacks (atastic seizures)
      2. tonic seizures
      3. absences
  3. poor prognosis
  4. neurodevelopmental disorder
  5. behaviour disorder
  6. often other complex neuro probs or hx of infantile spasms
3. childhood absence epilepsy
  1. age
    1. 4-12 years
  2. seizure pattern
    1. stop momentarily & stop moving
      1. may twitch their eyelids or hand minimally
    2. lasts a few secs, no longer than 30s
    3. child has no recall
      1. but realises they've missed something & may look puzzled or say 'pardon' on regaining consciousness
  3. developmentally normal
  4. developmentally normal
    1. but can interfere w/ schooling
  5. accounts for 2% of childhood epilepsy
  6. 2/3rds are female
  7. episodes can be induced by hyperventilation
    1. ask child to blow on a piece of paper or windmill for 2-3 min
      1. a useful test in the outpt clinic
  8. EEG
    1. show generalised 3/sec spike and wave discharge
      1. which is bilat synchronous during and sometimes btw episodes
  9. good prognosis
    1. 95% remission in teens
    2. 5-10% may develop tonic-clonic seizures in adult
Mx
1. prognosis
  1. do less well educationally, w/ social outcomes & w/ future employment
2. schooling
  1. 2/3rds of kids w/ epilepsy go to mainstream school
  2. some require educational help for assoc LD
  3. 1/3rd attend special school
    1. often have multiple disabilities and their epilepsy is part of a severe brain disorder
epilepsy syndromes
1. benign epilepsy with contemporal spikes (BECTS)
  1. age
    1. 4-10 years
  2. seizure pattern
    1. tonic-clonic seizures in sleep
    2. simple focal seizures w/ awareness of abnormal feelings in the tongue & distortion of the face
      1. supplied by Rolandic area of brain
  3. EEG shows focal sharp waves from the Rolandic or centrotemporal area
  4. important to recognise as it is benign & doesn't always require Rx
  5. Almost all remit in teenage yrs
  6. comprise 15% of all childhood epilepsies
2. early-onset benign childhood occipital epilepsy (Panayiotopoulos type)
  1. age
    1. 1-4 years
  2. seizure pattern
    1. younger kids
      1. periods of unresponsiveness, eye deviation, vomiting & autonomic features
    2. older kids
      1. headache & visual disturbance incl image distortion and hallucinations
3. juvenile myoclonic epilepsy
  1. age
    1. adolescence-adulthood
  2. seizure pattern
    1. myoclonic seizures
    2. generalised seizures
    3. absences
    4. typical hx
      1. throwing drinks/corn flakes about in morning
        myoclonus occurs at this time
      2. learning is impaired
  3. characteristic EEG
  4. response to Rx usually good but lifelong
  5. genetic linkage has been IDed
  6. remission unlikely

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Epilepsies of childhood-pt2

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	Created by v.djabatey over 10 years ago