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Update on epilepsy in pediatric patients
1Department of Neurology, Mayo Clinic Rochester, Minnesota, USA.
Insights
Pediatric epilepsy management involves accurate diagnosis and appropriate antiepileptic drugs (AEDs). For intractable seizures, surgical interventions offer effective treatment options for children with specific epilepsy types.
Area of Science:
- Pediatric Neurology
- Epileptology
- Neurosurgery
Background:
- Epilepsy affects 0.5-1% of children, with many responding to antiepileptic drugs (AEDs).
- Medically refractory seizures in children pose diagnostic and therapeutic challenges.
- Accurate classification of paroxysmal events is crucial to differentiate epilepsy from nonepileptic conditions.
Purpose of the Study:
- To review common pediatric epileptic and nonepileptic conditions.
- To discuss standard and novel antiepileptic drugs (AEDs) and their side effects.
- To highlight surgical treatment options for intractable pediatric epilepsy.
Main Methods:
- Review of common pediatric epileptic and nonepileptic conditions.
- Discussion of current and emerging antiepileptic drugs (AEDs) and their adverse effects.
- Analysis of surgical candidacy and presurgical evaluation techniques for pediatric epilepsy.
Main Results:
- Accurate classification of paroxysmal events is key for effective management.
- Advanced neuroimaging (MRI, PET, SPECT) and EEG aid in identifying epileptogenic zones.
- Surgical resection of focal cortical dysplasia, tumors, or hippocampal atrophy yields excellent outcomes in localization-related epilepsy.
- Specific conditions like infantile spasms, Sturge-Weber syndrome, and hemimegalencephaly may benefit from surgical interventions such as hemispherectomy.
Conclusions:
- Accurate diagnosis and appropriate AED selection are vital for pediatric epilepsy.
- Surgery is an effective option for medically refractory epilepsy in children.
- Multidisciplinary teams and experienced surgical centers improve outcomes for pediatric epilepsy surgery.
Abstract:
Epilepsy is a common condition that affects 0.5 to 1% of all children. Although most children with epilepsy have well-controlled seizures with use of one antiepileptic drug (AED), some children have medically refractory seizures. This situation can be the result of inaccurate classification of the paroxysmal event, use of an inappropriate AED, of a truly medically refractory seizure disorder. Paramount to the initial assessment of a child with presumed epilepsy is the appropriate classification of the paroxysmal event. Several nonepileptic conditions, such as motor tics or breath-holding spells, can cause paroxysmal abnormalities in children, which can be confused with epilepsy. The common pediatric epileptic and nonepileptic conditions are reviewed, and the standard and new AEDs and their side effects are discussed. When a child's seizure disorder is intractable despite adequate trials of AEDs, surgical treatment is increasingly becoming an effective option. Such procedures should ideally be performed at centers with extensive experience in this area and with a multidisciplinary team approach. With improved magnetic resonance imaging technology, increasing numbers of children with medically intractable localization-related epilepsy are being found to have underlying focal cortical dysplasia, tumors, or hippocampal atrophy. These abnormalities can often be surgically resected with excellent results. A generalized epilepsy may also be remediable with surgical treatment. Specifically, preliminary data suggest that infantile spasms, when triggered by an underlying focal cortical dysplasia, may be effectively treated by surgical resection. Patients with certain catastrophic seizure disorders, such as Sturge-Weber syndrome or hemimegalencephaly, require prompt intervention with hemispherectomy. The presurgical evaluation relies heavily on the magnetic resonance imaging, positron emission tomography, and single-photon emission computed tomography scan data as well as the electroencephalogram in identifying the area of epileptogenic abnormality.