Epilepsy in childhood-indroduction Epilepsy.Convulsion.Seizure.Fit.פרכוסהתכווצות כפיון, מחלה כיפיונית

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 ( Benzodiazepines- Diazepam, 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 child. ( preg, delivery p.m.h., medications,f.s p.m.h., medications,f.s Development. Development. Present : Detailed description before episode before episode (illness, trauma, meds (illness, trauma, meds activity, sleep ) activity, sleep )

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

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 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.SPECTPET

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 The study of choice in the work up of a child with work up of a child with Epilepsy is MRI. Epilepsy is MRI. In cases of Emergency in In cases of Emergency in ER, CT Scan is ER, CT Scan is reliable tool 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. Side effects.

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.