Let's move on to generalized seizures.
In a patient with generalized seizures, i
it's important to control the seizure but you probably got about five minutes
remember most pediatric seizures
will stop of their own accord within five minutes.
An EEG after a seizure is done maybe useful for identiyfing underlying seizure syndromes.
Let me give you an example.
Lennox Gastaut Syndrome
has an onset between typically three and five years of age.
These patients have mixed varieties of seizure
and they may develop mental retardation.
And severe behavioral problems.
Lennox Gastaut has a very typical EEG pattern.
It is not so important for a medical student or a resident
or even
a fellow would probably need to know it if there is a neurology fellow.
But most of us don't really need to know how to read EEGs
But we should be aware that there are certain patterns in them
that give away certain diagnosis.
And Lennox Gastaut does have a typical EEG appearance.
The reason why it is important to make the diagnosis of Lennox Gustaut is because
it is a difficult to manage disease and will require the guidance
of a pediatric neurologist.
Here is an example of an EEG.
What you see here is a patient with Lennox-Gastaut
You can here that there are intermittent periods of independent polywave spikes
lasting for roughly one to eight seconds.
And that is classic and emblematic of that disease.
Ok, let's move on to anti-epileptic drugs.
We'e got
Dilatin or Phenytoin
We've got Phenobarbital
and another that we might talk about is Ethosuximide.
This are all drugs that we are going to use
to place a child on all the time
to help prevent them from getting recurrent seizures,
when their seizures are frequent.
Dilantin is good for partial or generalized seizures
The problem is you need to know the serum drug levels of the patients
on this drug and over time they can develop side effects.
The side effects that you are going to be asked about on your tests
is probably Gingival hypertrophy.
They get excessively growing gums.
They also have
increased body hair. Usually in the arms you can see it very easily.
And long term, they can have neurotoxic effects
with actually a loss of IQ points over time.
So we like to avoid the seizure drugs unless we need them.
Phenobarbital generally used and better on children under one year of age.
It is good for partial or generalized seizures,
and again, we are going to have to follow drug levels.
Again, this can cause a loss of IQ points over time.
It has a general sedating effect, which
mitigates somewhat over time as they get used to the drug.
But be careful to warn the parents that for the next week or two,
their child may be excessively sleepy.
Ethosuximide is our first line
anti-seizure medicine for children with absence seizures.
So, I threw it in here as an alternative example
of a seizure medication that you will see children being on.
The side effects of Ethosuximide is drowsiness
behavioral changes, nausea
and they can get an Aplastic anemia or a lupus-like syndrome.
The general principle here is that there are lots of drugs we use in children
we need to know what the side effects are
and we need to know which drugs are most effective
in which seizure syndromes.
It really a matter of what the side effect profile
what are your monitoring needs and what is the seizure type.
Let's switch goals to focal seizures.
Now remember,
only children with focal seizures are going to have auras warning them
of an impending seizure.
Auras are unique things for each child. Sometimes they will see certain colors
or just get a sense that a seizure is coming on.
Focal seizures usually affect one area of the body.
Let's say an arm or a face.
The child may be fully awake during the event.
If we diagnose it with EEG,
but an MRI is absolutely indicated in a child with a first time focal seizure
because we need to rule out a focal abnormality in the brain.
We're going to treat focal seizures
with AEDs, implanted devices
and in bad cases, ketogenic diet or surgercal removal of the lesion.
Infantile spasms are a severe and
very sad disease that happens to infants and can have terrible progrnosis.
These look really unique.
And I urge you to go online and get to Youtube
and find a video of infantile spasms. They are all over the place.
It is important to be able to recognize them because diagnostically,
It is important to make this diagnosis.
These children have generalized myoclonic jerks of the neck, trunk and limbs.
It generally begins between 3 and 7 months of age.
The specific etiology of the majority are unknown or they're genetic or syndromic.
Children who are not actively seizing will start off with having a normal
neurologic exam and the typical EEG finding is something called
hypsarrhythmia.
You should probably remember that that might show up on a test.
Infantile spasms have a very bad diagnosis.
And it is a very bad prognosis.
The death occurs for about 1/3 within 3 years of diagnosis.
These children have profound cognitive effects from their recurring seizures
These seizures are profoundly hard to control.
and in survivors,
they gradually turn into other types of seizures
which can persist into adulthood.
Another type of seizure that is much less concerning is
Benign Rolandic Epilepsy.
This is also called Benign Epilepsy with Centrotemporal spikes or BECTS.
That's because
these patients tend to have Centrotemporal spikes on their EEG.
This present as several partial seizures usually in the face and in the hand.
It begins a little bit older between 5 and 12 years of age.
And usually with normal children who are developing normally.
What is key is they usually occur during sleep.
or within an hour of falling asleep.
Almost all are outgrown during adolescence.
They have those specific EEG findings,
and treatment is optional because they are asleep while having the problem.