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Frequently Asked Questions in Pediatric Epilepsy Lorraine M. Lazar, MD, PhD Pediatric Epilepsy Northeast Regional Epilepsy Group Individualized answers may differ based on patient diversity “My child doesn’t have epilepsy, right?” “Epilepsy” = unprovoked seizures due to spontaneous electrical misfiring in the brain, not due to ‘acute’ (temporary) medical illness or temporary brain irritation Misperceptions NOT synonymous with “Cerebral Palsy” “Cognitive “Mental Fragile NOT Disability” Retardation” / Sickly uncommon 326,000 children in the U.S. < 15 years old have epilepsy 200,000 new cases diagnosed each year TreatmentEpileptic guidedSeizure by eizure Classification (simplified) PARTIAL Simple Absence GENERALIZED Complex Myoclonic Tonic-Clonic Tonic Atonic “What caused my child’s epilepsy?” Multiple Causes of Epilepsy SYMPTOMATIC IDIOPATHIC “Why did the seizures start now?” Age Related Onset Of Childhood Epilepsy Syndromes JME Juvenile Absence GTC on awakening Childhood Absence Rolandic Lennox-Gastaut Febrile Seizures Benign Myoclonic Infantile Spasms Early Epil Encephalopathy Neonatal seizures Age (yrs) at Seizure Onset “Will my child have to take medication forever?” ~ 65 % of children seizure free on medication for 2 years will remain seizure free after medication discontinued If seizures return off medication, they are typically controlled by restarting medication Examples of low risk of seizure recurrence off medication: Benign Rolandic Childhood Absence Examples of high risk of seizure recurrence off medication: Lennox-Gastaut Juvenile syndrome Myoclonic Epilepsy Factors associated with a higher risk of seizure relapse if medication is discontinued Increased seizure recurrence risk if abnormal neurologic exam or epileptiform EEG NonEpileptiform EEG NonEpileptiform EEG Epileptiform EEG Epileptiform EEG NORMAL EXAM ABNORMAL EXAM NORMAL EXAM ABNORMAL EXAM Tonic-Clonic 30 % 51 % 47 % 73 % Simple Partial 50 % 75 % 71 % 92 % Complex Partial 58 % 83 % 77 % 96 % “How do I keep my child safe?” Medication Compliance Regular doctor’s appointments Pill Sorter Inform doctor of insurance issues Avoid seizure triggers sleep deprivation missing medication (forgetting, running out) illness/fever excessive alcohol use, illicit drug use flashing lights stress/anxiety Know Basic Seizure First Aid (at Home and School): 1. Stay calm 2. Time the seizure 3. Roll onto side 4. Move objects away 5. Don’t restrain 6. Don’t put anything in the mouth 7. Be reassuring as seizure stops Water Safety – minimize drowning hazard Bathe under constant supervision (unlocked bathroom door) Consider Never Wear shower (with clear drain) over bath swim alone life vest in murky water Sports Safety: Always wear appropriate sports safety gear (helmets a must!) Avoid climbing heights without a harnass Avoid bicycling in open traffic Travel Safety: Avoid sleep deprivation Carry medications on trips Have enough medication to last the trip For older teens, follow DMV laws for driving Medication Safety: Inform your epilepsy doctor of other medications being taken, whether prescribed or over-the-counter Benadryl – can lower seizure threshhold “Can my child die from seizure?” SUDEP – Sudden Unexpected Death of someone with Epilepsy, who was otherwise healthy. Rare in children More common in adults, especially if seizures uncontrolled Cause of death in SUDEP unclear irregular heart rhythm? suffocation from impaired breathing, fluid in the lungs, being face down on bedding? Best prevention is to follow treatment recommendations, including take anti-seizure medication regularly “Should my child see a seizure specialist?” YES!