Global Perspectives
| Review Articles | |
| MANAGEMENT OF EPILEPSY IN CHILDREN - Compiled by Dr Madhuri Kulkarni* & Dr Shubhangi Upadhaye** * Prof. & Head, ** Lecturer, Dept. of Paediatrics, LTM Medical College & LTMG Hospital, Mumbai |
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Should EEG be recommended in all children after a first unprovoked seizure? As an EEG is often recommended as part of the standard diagnostic evaluation after the first seizure. Gilbert DL in 1999 at Dept. of Neurology, Cincinnati conducted a study to quantify and analyze the value of expected information from an EEG after first unprovoked seizure in childhood3. A MEDLINE search from 1980 to 1998 was performed. Data on EEG results and seizure recurrence risk in children was abstracted, and sensitivity, specificity, and positive and negative predictive values of EEG in predicting recurrence were calculated. Linear information theory was used to quantify and compare the expected information from the EEG in all studies. Standard test-treat decision analysis with a treatment threshold at 80% recurrence risk was used to determine the range of pretest recurrence probabilities over which testing affects treatment decisions. Data of four studies involving 831 children was included in the analysis. It was seen that EEG had a sensitivity of 61%, a specificity of 71%, and an expected information of 0.16 out of a possible 0.50. The pretest probability of recurrence was less than the lower limit of the range for rational testing in all studies3. The findings of this analysis indicates that, the quantity of expected information from the EEG was too low to affect treatment recommendations in most patients. Hence the authors have concluded that an EEG should be ordered selectively, not routinely, after first unprovoked seizure in childhood3. Occurrence and outcome of epilepsy in children Dr. Rantala at Department of Pediatrics, University of Oulu, Oulu, Finland conducted a study to was to analyze the occurrence and outcomeof epilepsy between the ages of 28 days and 2 years4. The objective of the study was to evaluate the association of epilepsy during the first 2 years of life with both mental development and the persistence of epilepsy in a defined population with a longer follow-up time. The study included all children who were born between January 1, 1976, and December 31, 1986, in an area with a mean annual live birth rate of 5027 and who were treated for epilepsy at that age. Follow-up data were gathered from medical records and/or with a questionnaire. The results demonstrated that by age 2 years, 72 children had epilepsy, giving a cumulative incidence (CI) rate of 1.3 cases per 1000 children (95% CI, 1.0-1.6). Thirty-two (97.0%) of the 33 children with cryptogenic epilepsy were without medication at the time of the last visit and had been in remission for a mean period of 13.0 years (range, 7.4-19.7 years), in contrast to only 5 (15.6%) of the 32 children with symptomatic epilepsy (difference, 81.3%; 95% CI of the difference, 63.0%-91.3%; P <.0001). Thirty-one (93.9%) of the 33 children with cryptogenic epilepsy were mentally normal, as opposed to only 3 (9.4%) of the 32 children with symptomatic epilepsy (difference 84.6%; 95% CI of the difference, 66.3%-93.4%; P <.0001)4. The study concluded that in children whose epilepsy starts between the ages of 28 days and 2 years the poor outcome is clearly due to the underlying brain disease. In cryptogenic epilepsy the outcome is good in children with earlier onset of epilepsy than that reported for later onset4. Conclusion Although there is no cure for heterogeneous illnesses such as epilepsy, the treatment of epilepsy in children has come a long way in the past few years, and much of this improvement can be attributed to the development of new techniques of diagnosis and management. Reference:
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