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Partial seizures in children: clinical features, medical treatment, and surgical considerations
E Wyllie1, A D Rothner, H Lüders
1Section of Pediatric Neurology, Cleveland Clinic Foundation, Ohio.
Insights
Partial seizures in children, characterized by focal onset, are classified as simple or complex. Diagnosis involves EEG and neuroimaging, with treatment ranging from medication to epilepsy surgery.
Area of Science:
- Pediatric Neurology
- Epileptology
Background:
- Partial seizures are common in children and originate from one cerebral hemisphere.
- They are categorized into simple partial seizures (without consciousness impairment) and complex partial seizures (with consciousness impairment).
Observation:
- Symptoms vary, including motor, sensory, autonomic, or psychic phenomena, and can progress from simple to complex partial seizures.
- Automatisms, repetitive involuntary movements, are common in complex partial seizures, particularly those with temporal lobe onset.
- Electroencephalogram (EEG) showing focal spikes or sharp waves supports the diagnosis, though a normal EEG does not rule out epilepsy.
Findings:
- Underlying etiologies, often static insults, are found in a significant percentage of pediatric partial seizures.
- Neuroimaging like MRI or CT is crucial for identifying potential causes such as slow-growing gliomas or mass lesions.
- Treatment typically starts with monotherapy, escalating to dual-drug regimens if necessary, with epilepsy surgery considered for refractory cases.
Implications:
- Early and accurate diagnosis of pediatric partial seizures is vital for effective management.
- Referral to specialized epilepsy centers is recommended for surgical evaluation and treatment.
- Advances in neuroimaging and surgical techniques offer improved outcomes for children with intractable partial epilepsy.
Abstract:
Partial seizures are not uncommon in children. They are classified into two types: simple partial, without impairment of consciousness, and complex partial, with impaired consciousness. For both types, the hallmark is onset of the seizure from a portion of one cerebral hemisphere, as indicated by focal spikes or sharp waves on EEG. The symptoms of simple partial seizures may include focal motor or somatosensory phenomena, special sensory phenomena, autonomic symptoms, or psychic symptoms, and these symptoms may occur alone or they may progress into a complex partial seizure with alteration of consciousness. The complex partial phase may include simply an arrest of ongoing activity with altered awareness and a blank empty stare, or there may also be automatisms, including movements which are gestural, alimentary, mimicking, verbal, or ambulatory. Automatisms are predominantly seen in complex partial seizures arising from temporal areas, but they also may be seen in seizures with extratemporal onset. If the epileptic discharge spreads throughout both cerebral hemispheres, the child will have a secondarily generalized tonic-clonic convulsion. EEG should be performed in any child who is suspected of having partial seizures. If there are focal spikes or sharp waves, then there is strong supportive evidence for a diagnosis of partial seizures in the proper clinical setting. It should be remembered, however, that a normal routine EEG cannot be used to "rule out" a diagnosis of epilepsy in patients who have episodes that sound like simple or complex partial seizures. An underlying etiology may be found in a significant percentage of children with partial seizures. Most of these etiologies are static, and the seizures are the result of a previous cerebral insult, but some patients may have slow-growing gliomas or other mass lesions. MRI or CT is indicated in essentially any child with partial seizures. Medical treatment is based on the idea of using single drugs to maximally tolerated doses, if needed, before beginning with two-drug regimens. If the child continues to have seizures despite aggressive trials of medication, then it is important to consider epilepsy surgery, either temporal lobectomy or other cortical resection. When children are identified as candidates for epilepsy surgery, they should be referred to specialized centers for further testing.(ABSTRACT TRUNCATED AT 400 WORDS)