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Complex Partial Seizures in Children
1Department of Neurology, Divisions of Child/Adolescent Neurology and Epilepsy, Mayo Clinic, 200 First Street, Rochester, MN 55905, USA.
Insights
Accurate diagnosis is key for treating complex partial seizures (CPS) in children. Early, aggressive therapy and surgical options should be considered for optimal seizure control.
Area of Science:
- Neurology
- Pediatric Epilepsy
Background:
- Accurate diagnosis is crucial for effective treatment of complex partial seizures (CPS).
- Distinguishing CPS from other seizure types like absence seizures is vital due to differing prognoses and treatments.
- Many children with CPS do not spontaneously remit, necessitating proactive management.
Purpose of the Study:
- To outline diagnostic and therapeutic strategies for complex partial seizures in children.
- To emphasize the importance of early and aggressive treatment for pediatric CPS.
- To discuss pharmacologic and surgical management options for pediatric CPS.
Main Methods:
- Comprehensive diagnostic evaluation including electroencephalography (EEG) and high-resolution magnetic resonance imaging (MRI).
- Exclusion of nonepileptic events and other seizure types.
- Assessment of pharmacologic options and surgical candidacy.
Main Results:
- High-quality MRI is essential; CT scans are inadequate for evaluating brain abnormalities in seizures.
- A variety of antiepileptic drugs (AEDs) are effective for CPS, even if not specifically approved for young children.
- Surgical resection is a viable option for intractable pediatric CPS, particularly with identified structural abnormalities.
Conclusions:
- Early and aggressive treatment, aiming for complete seizure freedom, is recommended for pediatric CPS.
- AED selection should prioritize side-effect profiles due to unpredictable individual responses.
- Surgical intervention should be considered for all ages with medically intractable CPS.
Abstract:
The treatment of complex partial seizure (CPS) begins with accurate diagnosis. Episodes of staring and unresponsiveness due to nonepileptic causes must be ruled out. Absence seizures (typical and atypical petit mal) must be considered because the treatment strategy and prognosis for these seizures are very different from those for CPS. Diagnostic evaluation should include electroencephalography (EEG) done during both the awake and the sleep states. Standard activation procedures and high-quality magnetic resonance imaging (MRI) of the brain with sequences specifically designed to evaluate mesial temporal structures and subtle regions of cortical dysplasia should be used. Computed tomography is not adequate for brain imaging in the evaluation of persons with seizures. Because most children with CPS will not "grow out of their seizures" and only 50% will have seizures adequately controlled, early aggressive therapy should be pursued. The goal of therapy should be complete freedom from seizures. Although only a few antiepileptic drugs (AEDs) are specifically approved for CPS in children younger than 12 years of age, a variety of pharmacologic options exist. This is because 1) AEDs that are effective in any type of partial seizure are likely to be effective in CPS, 2) AEDs that are effective in adults with partial seizures are effective in children with seizures of the same type, and 3) AEDs that are effective as adjunct therapy can be effective as monotherapy. The choice of an AED should be strongly influenced by side-effect profiles because it is not yet possible to predict which AED will be most effective in an individual child or adolescent. Surgical resection should be considered for children of all ages if seizures are intractable to adequate medical intervention, especially if a structural abnormality is detected on neuroimaging.