Paediatrics Epileptiform Disorders
Paediatrics Epileptiform Disorders
Paediatrics Epileptiform Disorders
Now:
Either according to main symptom
Emotion
• Motor (clonic / tonic) • Autonomic
• Sensory • Visual Hearing Vision
Or According to where in the brain they arise Smell
• Frontal lobe
• Temporal lobe
Vision Emotion
• Parietal lobe Motor functions
• Occipital lobe Simple sensation Hearing Higher intellectual
Spatial body perception Smell functions
Case 3
12yr old boy
Unilateral tonic-clonic seizure involving face & arms
in sleep or on awakening
Occasionally with GTCS in sleep
If occur awake consciousness preserved
International system
Benign Epilepsy with Centro-Temporal
‘10-20’ Spike (rolandic)
Most common focal epilepsy in childhood (10-15%)
Fp1 Fpz Fp2 Onset: 4-10yrs
Seizure:
F7 F3 Fz F4 F8 - Focal sensorimotor (unilateral parasthesia)
- +/- by focal motor sz face, lips, pharynx
C3 Cz
A1 T3 C3 Cz C4 T4 A2
- GTCS in sleep
70-75% sz occur during sleep or on awakening
If awake consciousness preserved but if asleep
T5 P3 Pz P4 T6 secondary generalisation is common
NB: GTCS may be only manifestation
O1 Oz O2
Prognosis 30% 1sz, 50% 2-5sz, 5%>10sz 90% have frequent seizures
50 µV
Case 4 0.5 sec
F 4 -C 4
6/12 old boy F 3 -C 3
C 3 -A 1
Sz on 1st wk of life which then resolved A 2 -T 6
T 6 -O z
nods‟ A 2 -T 4
T 4 -C 4
C 4 -C z
C z- C 3
C 3 -T 3
T 3 -A 1
T 4 -T 3
T 6 -T 5
E CG
50 µV
0.5 sec
Infantile spasms
F 4 -C 4
• Infantile “epileptic encephalopathy”
C 4 -P 4
P 4 -O z
• Rare: incidence of 0.25-0.60 per 1000 live births
F 3 -C 3 • Peak age of onset 3-7 months, >95% have onset before age 2
C 3 -P 3
• West syndrome
P 3 -O z
F 4 -A 2
= triad of infantile spasms, hypsarrhythmia and arrest
A 2 -T 6 of psychomotor development
T 6 -O z
• Semiology: periodic spasms or brief tonic stiffening that cluster
F 3 -A 1
associated with behavioural change
A 1 -T 5
T 5 -O z
• Symptomatic:
T 4 -C 4
5 0 µ V – Seen in 61-93% of cohort in recent studies
C 4 -C z
1 sec
– Further divided into pre-, peri- and postnatal causes.
C z- C 3 – Usually associated with a structural CNS abnormality
C 3 -T 3 • Unknown: “lack of previous signs of brain damage and of
E CG unknown aetiology”
2 weeks on Vigabatrin