Epilepsi Pada Anak

 

REFLEKSI K SUS EPILEPSI

Della Rizki Anggilia 18105

 

Seizure •

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Definition “A seizure represents the clinical expression of abnormal,:excessive, synchronous discharges of neurons residing primarily in the cerebral cortex”  When the seizure is prolonged or immediately recurrent without a return of consciousness, this is status epilepticus.

 

Epilepsy

 

Types of Seizures ILAE classified seizures into 4 types based on clinical and EEG data: •

Focal (partial) seizures : limited to one hemisphere, discretely localized orwith moreimpa widely distributed distributed, , may orduring may not be (sim associ associated ated impairment irment of awarenesss aware nesss att attack ack (simple ple vs complex partial seizure). Subtype: motor motor,, sensory, autonomic, focal without impairment of awareness, focal with impairment of awareness.

 

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Generalized seizure : both hemisphere, awareness may be impaired as initial manifestation, motor manifestation are bilateral, can have motor manifestation or may be absence. Epileptic spasm : infantile spasm that involve spasm of muscles of neck, trunk and extremities. There is insufficient knowledge about the mode of seizure onset to categorize spasm a focal/generalized and they are considered of unknown type by ILAE 2017

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Impact of age : Typical Typical generalized generalized tonic-clon tonic-clonic ic and absence seizures are extremely uncommon in the first two years of life and never occur in the newborn. These issues, unique to the child between two months and two years, have prompted proposals for classifications specifically directed to this age group.

 

Epidemiology •

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Incidence of epilepsy is 0.5-8 per 1000 person per years 3-5% will have febrile seizure in first five years of life and 30% will have additional febrile seizure. 3-6% of those febrile seizure will develop afebrile a febrile seizures or epilepsy epilepsy..

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Male > female

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Partial > generalized seizure

 

Etiology •

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Genetic Structural or metabolic : can be caused by transient disruption such as high fever, hypocalcemia, hyponatremia, minor head trauma (concussion), bleeding, ischemia, inflammatory excitation excita tion such as meni meningitis, ngitis, en encephali cephalitis, tis, sepsi sepsis, s, etc or chronic disturbance such as perinatal asphyxia, tumor or neurodegenerative disease.

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Neurodevelopmental lessions

 

Clinical Characteristics •

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Stereotyped (each onetime is like one) Random (occur at any of the the previous day or night) Rarely precipitated by specific environmental, psychological or physiological events Some individuals have several different types of seizures Exceptions: some individuals have seizures only during sleep, others only upon awakening in the morning, others always at the time of menstruation menstr uation (catamenial (catamenial seizures), seizures), and some following following specific stimuli such as certain sounds, flashing lights, stubbing the foot, or being tapped on the shoulder (reflex seizures). The latter seizures (sensory provoked) are rare, but uncovering this information may allow the clinician to classify the child as having a specific epileptic syndrome and develop specific therapy (eg, special glasses with filtered lenses for visually-provoked seizures)

 

When to Start Antis Antiseizur eizure e Drug Therapy •

First-time unprovoked seizure: seizure: risk for recurrent seizures, effect of early versus deferred therapy

 

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Second unprovoked seizure : usually usually g get et antiseizur antiseizure e drug ttherapy herapy since seizure recurrence indicates that the patient has a substantially increased risk for additional seizures (epilepsy). Exceptions Excep tions if paren parents ts choose to no antiseizure antiseizure drugs if the seiz seizure ure infrequent and/or mild (subjectively). By contrast, children with absence/atonic seizure always treated because usually present to clinician with established pattern of frequent seizure.

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Acute symptomatic seizure: seizure: have low risk of recurrence unless the underlying etiology recurs. Febrile seizure : AAP concludes that neither continuous nor no r intermittent interm ittent anti anticonvuls convulsice ice therapy is recom recommended mended for childre children n with one or more simple febrile seizure.

 

Sel Select ection ion of an Antis Antiseiz eizure ure Drug •

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Single-drug therapy is the goal of treatment Seizure Seizu re type-relat type-related ed considera consideration: tion: Cortic Corticotropi otropin n (ACT (ACTH) H) for infantile spasm, Valproate Valproate for absence a and nd juvenile myoclonic epilepsy epileps y, broad-spect broad-spectrum rum antiseizure antiseizure for generalize generalized d epileps epilepsy y syndromes (narrow-spectrum seizure), carbamazepine and phenytoincan canworsen worsenthe absence and myoclonic seizure Choose that require only once-twice daily and allow for make-up dosing Look for the side effect of each drugs choosen Teratog eratogenicity enicity:: valpr valproic oic acid ca can n incre increase ase ris risk k of spina spina bifida for th the e baby in pregnant women

 

Stoppi pping ng Antis Antiseiz eizure ure Dru Drug g The Therapy rapy Sto •

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Withdrawal antis Withdrawal antiseizure eizure drug shoul should d be consider considered ed in most children after 2 years without seizures regardless of the etiology. Risk of recurrence after 2 years without seizure is 3040% Tapering off in several weeks to few months are generally recommended

 

TERIMA KASIH Mohon asupan