Download Epilepsy in childhood

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.
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)
Epilepsy in childhood-indroduction
Clinical presentation:
Motor ( 80%-90%)
Sensory.(skin, vision, hearing, taste,
smell)
Behavioral .
Autonomic.
Epilepsy in childhood-indroduction
Neurophysiologic basis.
Neuron, dendrites, axon.
Action potentials.
Synaptic neurotransmitors
Excitators (glutamic , aspartic ac)
Inhibitors (GABA )
Epilepsy in childhood-indroduction
Classification of epilepsy:
Nature of episode.
Origin.
Electrical Abnormality.
Name of Physician who describe
Epilepsy in childhood-indroduction
Current classification of epilepsy since
1989:
Partial ( focal ).
Generalized .
Partial with generalization
Status Epilepctus .
Epilepsy in childhood-indroduction
Clinical description of motor
seizures :
Clonic.
Myoclonic.
Tonic
Atonic ( Akinetic).
Epilepsy in childhood-indroduction
Epileptic episode may include:
Aura.
Ictal phase ( ictus).
Post ictal phase.
Epilepsy in childhood-indroduction
Epileptic episode may be
primary or secondary due to…
Primary – genetic or idiopathic.
Epilepsy in childhood-indroduction
Secondary epileptic episode :
C.N.S malformations
Metabolic.( metabolic , primary )
Infectious.
S.O.L.
Trauma
Toxic ( medications, abuse)
Epilepsy in childhood-indroduction
Clinical Approach to a child with
first seizure:
In the E.R.:
Treatment , stabilization.
Physical /neuro examination.
Work -up
Epilepsy in childhood-indroduction
Observation ( patient , watch ).
Position , Oxygen mask.
I.V. line. (other 3 options )
Medications ( BenzodiazepinesDiazepam , midazolam)
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
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, med’s
Epilepsy in childhood-indroduction
Medical History:
Past :
family ( epilepsy )
child. ( preg , delivery
p.m.h. , medications,f.s
Development.
Present : Detailed description
before episode
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 )
Epilepsy in childhood-indroduction
Work – up in the E.R.:
Two major urgent decisions
Neuroimaging.
Spinal tap. (open nl fontanella
or Neroim. )
Epilepsy in childhood-indroduction
Neuroimaging :
C.N.S bleeding .
S.O.L.
Acute hydrocephalus.
L.P:
C.N.S. infection ( bac, viral
others )
Epidural Hemorrhage in ITP
Epidural Hemorrhage in ITP
Space Occupying Lesion
Epilepsy in childhood-indroduction
Hospitalization :
Observation (recurrent seizure).
Diagnostic evaluation.
Parental care and explanations .
Epilepsy in childhood-indroduction
Diagnostic Work–up during
Hospitalization:
EEG.
Neuroimaging.
Others.
Epilepsy in childhood-indroduction
E.E.G.
Recording of electrical activity
of brain.
Non invasive.
Cheap.
Available.
Portable , bedside, ( picu, nicu).
Epilepsy in childhood-indroduction
E.E.G.
Complete study includes:
Alert.
Sleep, drowsy.(Sleep deprived)
Photic stimulation.
Hyperventilation.
Epilepsy in childhood-indroduction
E.E.G.
Regular study.
24h ambulatory study
Video EEG Study.
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
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.
Epilepsy in childhood-indroduction
2 Exceptions :
Infantile spasms (West synd)
Simple Absence Seizure.
Epilepsy in childhood-indroduction
Simple Absence Epilepsy
Epilepsy in childhood-indroduction
Abnormal EEG could be seen in
CNS infection.
Head trauma.
S.O.L.
Toxic metabolic conditions.
Headache , Migraine.
ADHD , LD.
Epilepsy in childhood-indroduction
Are all epileptic episodes
required neuroimaging ?
Neuroimaging Modalities:
Ultrasound.
CT Scan.
MRI.
SPECT
Epilepsy in childhood-indroduction
Ultrasound of brain.
Non invasive.( no radiation)
Cheap and available.
Portable
No need for sedation
Epilepsy in childhood-indroduction
CT Scan.
Relatively cheap.
Available.
Radiation.
Sedation.
Epilepsy in childhood-indroduction
MRI.
Expensive.
Non available.
Sedation.
No radiation
fMRI
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
Epilepsy in childhood-indroduction
SPECT ( single photon
emission computed tomography)
Epileptic focus.
Focal blood perfusion.
Not available.
Only after epileptic episode.
Epilepsy in childhood-indroduction
PET ( position emission
tomography)
Demonstrate the content of 02
And glucose .
Epileptic hypermetabolic focus.
Expencsive.
Non available.
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.
Epilepsy in childhood-indroduction
Treatment of Epilepsy.
-Anti epileptic medications.
-Other medications( steroids ,
vitamines (B complex), diamox)
-IV IG.
-Ketogenic diet.
-VNS.
-Epileptic surgery.
Epilepsy in childhood-indroduction
Treatment of Epilepsy.
How to select an anti epileptic
drug?
Type of seizure/ syndrome.
Medical history ( liver , kidney )
Allergies.
Epilepsy in childhood-indroduction
Treatment of Epilepsy.
Duration of treatment.
Side effects.
Follow up (clinical , laboratory)
Drug levels.
Recurrent seizures.
Compliance.
Epilepsy in childhood-indroduction
Outcome
Type of epileptic syndrome.
Response to treatment.
High rate of cure .
Driving Liecence.
Army service.