Seizures and Epilepsy in Children

Abstract

Seizures and epilepsy in children are common. They are caused by a variety of causes ranging from genetic to neuro -infections. History and actual observation or/video are very important to differentiate true seizure from non-epileptic event. A correct classification of seizure and epilepsy helps to decide need to treat, choice of anti-epileptic drugs (AED) and prognostication. Except for few seizure types, in majority of seizure types regular AED are started after second confirmed seizure. Goal of treatment is seizure control with minimal side effects and ensuring quality of life. With appropriate mono - therapy, about 70 % patients become seizure free and can be easily treated in community. An orderly approach to classify seizure type, holistic management and timely referral of intractable epilepsy will help in improving care of children with epilepsy.

Improving Pediatric Care for Epileptic Children - What Does the Pediatrician Needs to Know about Antiepileptic Drugs?

“…AED is required for longer duration in epileptic syndromes and if there are multiple risk factors for recurrence. Prominent risk factors include age greater than 12 years at onset, neurologic dysfunction, a history of prior neonatal seizures and numerous seizures before control is achieved [2][3][4].…”

“…Restart previous AED, most patients will remit again. The risk factors for relapses, including: Epilepsies with structural brain lesions, abnormal neurological signs and abnormal EEG [4,5].…”

“…Routine serum monitoring of anticonvulsant levels is not recommended because the practice is not cost effective. The indications for AED monitoring, including: (*) at the beginning of AED therapy; (*) for noncompliant children and caregivers; (*) during status epilepticus; (*) during accelerated growth spurts; (*) for patients on polytherapy (*) for patients with intractable seizures or seizures that have changed in type; (*) for manifestations of drug toxicity; and (*) for children with hepatic or renal disease [2,4].…”

Childhood Epilepsy: An Update on Diagnosis and Management

“…In the USA; between 25,000 and 40,000 children will have a first non-febrile seizure each year. The problem is further compounded in developing countries as they add about 75-80% of new cases of epilepsy (Guerrini, 2006;Tamber and Mountz, 2012;Sharma, 2013). The seizures and epilepsies in children are extremely diverse, differing markedly in age of onset, seizure characteristics, associated comorbidities, treatment and prognosis.…”

“…Without a firm understanding of the complexities of childhood epilepsy, it may be not possible for such physicians to always make an accurate diagnosis and plan an effective treatment strategy. So it is important for the general pediatrician to be aware of the evaluation and management of these patients (Tamber and Mountz, 2012;Sharma, 2013). Also, pediatricians and practitioners should have a role in preventing epilepsy by minimizing neurological insults in early infancy and childhood.…”