Indian Write- Ups
| Paediatrics | |||
| Epilepsy In Children | |||
Introduction
A simple febrile seizure can be understood as a brief (< 15 minutes) generalized seizure that occurs only once during a 24-hour period in a febrile child who does not have an intra-cranial infection or severe metabolic disturbance. Likelihood of Recurrence The recurrence risk for children meeting criteria for this guideline is less than 50% at one year. In children with normal cognition and motor function and no prior neurological injury, as much as 1 of 3 children will have a relapse within one year. In those days with previously abnormal cognition or motor function, 2 of every 3 children will have a relapse within one year. For those who are likely to suffer a recurrence, as much 90 – 95% of such children will suffer an epileptic attack within two years of the initial event. Imaging An EEG needs to be performed if a second seizure occurs. In previously normal children, one-year recurrence risk with an epileptifrom EEG is 44%. While it is 20% for a non-epileptiform EEG. Pharmacological Intervention With medication, the chances of the subsequent recurrence of febrile seizures or afebrile seizures including epilepsy may be minimised. In randomized, controlled studies, only 4% of children taking valproate as opposed to 35% of control subjects had a subsequent febrile selzure. Therefore, valproic acid seems to be at least as effective in preventing recurrent, simple febrile seizures as phenobarbital and significantly more effective than placebo. Drawbacks to therapy with valproic acid include its rare association with fatal hepato-toxicity (especially in children younger than 3 years who also are at greatest risk for febrile seizures), thrombocytopaenia, weight loss and gain, gastrointestinal disturbances, and pancreatitis. Adverse effects associated with the use of phenobarbital include behavioural problems such as hyperactivity and hypersensitivity reactions. |
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