Childhood epilepsy

Epilepsy is defined as two or more unprovoked seizures.

A seizure is an abnormal synchronous depolarization of the group of neurons.

Affects 0.5-1% of all children.

.7% of children and adolescents have at least one seizure during the preceding year.

150,000 children and adolescents have a single unprovoked seizure annually in the United States.

About 1/5 of children and adolescence experiencing a seizure in a year will develop childhood epilepsy.

15% of children with seizures will have medically refractory seizures.

Children who are more likely to have seizures include those in poverty or low income families, and are less likely be part of a nuclear family.

Children who experience seizures are less likely to have a college degrees parents.

Differential diagnosis in childhood epilepsy include: breath holding spells, benign paroxysmal vertigo, paroxysmal choreathetosis, migraine, syncope, pseudo seizures, sleep disorders, tics, and stuttering.

Classification of childhood epilepsy has been established by the International Classification of the Epilepsies and Epileptic Syndromes.

Seizures are divided into generalized and partial seizures.

Generalized seizures refers to seizures without focal features.

Clinically generalized seizures are manifested with myoclonic, tonic, atonic, absence, and tonic-clonic.

Generalized seizures on EEG (electroencephalogram) demonstrate spike, polyspike or sharp wave discharges, or some combination, without localizing features over cerebral hemispheres.

Partial seizures manifest as focal events, being initiated in one part of the brai, and manifestations are dependent on the site in the brain that the discharge begins.

Simple partial seizures may not be associated with alteration of consciousness, and they may be an aura that the patient experiences before they have a more recognizable seizure.

Typically simple partial seizures transform into complex partial seizures with a focally generated seizure associated with the alteration of consciousness.

Complex partial seizures can become generalized tonic-clonic seizures.

The International Classification of Epilepsy Syndromes also classifies seizures on the basis of age of onset, the type of seizure, family history, risk factors for epilepsy, associated neurodevelopment delays, neuroimaging studies, EEG information, ictal and inter-ictal activities, and diagnostic tests such as lumbar puncture, metabolic testing and physical examination.

About two-thirds of children with epilepsy will ultimately achieve seizure freedom.

Many children with epilepsy will be able to stop taking medication and remain seizure-free.

American Academy of Neurology recommends consideration of antiseizure medication withdrawal for children who are seizure free for at least 18 to 24 months in the absence of an epileptiform electroencephalogram or an electroclinical epilepsy syndrome.

The likelihood of recurrence after a two-year period without seizures is approximately 30 to 40 percent.

About 20 percent of children with epilepsy are deemed medically intractable, having failed to improve after trials of multiple medications.

In children, uncontrolled seizures result in considerable comorbidity, including intellectual disability, physical injury, depression and anxiety, and failure to achieve independence.

Surgery offers the benefit of quicker seizure control, but is irreversible and not without risk.

Abnormal neuroimaging is a strong prognostic factor in childhood epilepsy, and it is the most significant predictor of pharmacoresistance in childhood epilepsy.

Mortality rates in children with epilepsy are four to five times higher than in the general pediatric population.

The death rate among children with uncomplicated epilepsy is not much greater than expected for the general population.

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