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Approach to a child with Epilepsy
-Dr K.N. Shah |
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Once epilepsy is diagnosed :
THIRD STEP
What type of epileptic seizure is the child suffering form ?
I .Generalised Seizures
- Generalised tonic-clonic seizure
Generalised tonic seizure
Generalised clonic seizure
- Myoclonic seizure
- Atonic seizure
- Absence seizure
- Infantile spasms.
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II. Partial Seizures
- Simple where consciousness is not lost and the child remains responsive to commands. This may be motor, somato-sensory, autonomic or psychic.
- Complex partial seizures:Simple partial seizures may progress to complex partial seizures with loss of responsiveness or consciousness or consciousness is lost at the onset followed by seizures.
- Secondary generalised seizures which occur when simple or complex partial seizures become generalised. Commonly into tonic-clonic seizures.
- Unclassified: Few types of seizures cannot be classified into any definite category e.g. neonatal seizures
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ILAE (1981) classified various seizure types based on clinical, routine scalp EEG (ictal and inter ictal) and in few cases video EEG studies. As video EEG studies are done at very few centers in India and EEG may be normal in some cases, classification depends on history and observation of episodes.
| Symptoms according to localisation in partial seizures :
Partial seizures can arise from the frontal lobe, temporal lobe, occipital lobe and partial lobe. Temporal and frontal lobe parietal seizures are the commonest. It is not always easy to differentiate clinically because of overlap in semiology and rapid spread from one area to another which may ultimately lead to secondary generalisation. Scalp EEG also may or may not localise the site and may show multifocal neuronal hyperexcitability. |
FOURTH STEP
What is the nature of an epileptic syndrome?
Epilepsy seizure type is one which patient presents with while epilepsy syndrome is decided by the clinician, based on age, semiology of seizures, etiology, anatomy, precipitating factors, severity, chronicity, diurnal variation, prognosis and response to treatment. It is a cluster of signs and symptoms occuring together. Seizure type does not take into account etiology, age of onset, precipitating factors, chronicity etc.
| Syndromes are divided into localisation related or generalised
Localisation related syndromes are further divided into
- Idiopathic
- Symptomatic, and
- Cryptogenic
Generalised are further divided into
- Idiopathic
- Cryptogenic or secondary
- Specific syndromes
- Some of the syndromes remain undetermined
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