Epilepsy in children

1- idiopathic partial epilepsies:

* Partial Epilepsy benign rolandic to climax

– This is the most common childhood epilepsy between 3 and 13 years. Predominantly male. The prognosis is excellent and healing after puberty.

– Seizures are partial with preserved consciousness, nocturnal schedule, late night. They are clonic or tonic-clonic, at hemifacial and oral pharyngolaryngeal region.

– They can extend the upper limbs or secondarily generalized. Parents are awakened by vocalizations related anarthria.

– The EEG shows centro-temporal spikes, slow, two-phase, high voltage which potentiate sleep.

– Treatment of crises is not essential if seizures are infrequent (1-2 per year). We must propose a single drug.

2- idiopathic generalized epilepsy:

* Benign familial neonatal epilepsy

It manifests dice the 3rd day of life, by clonic seizures, tonic-clonic. Clinical examination is normal. The EEG is not specific. Patients may subsequently show epilepsy.Heredity is dominant mutation in the potassium channel.

* Epilepsy-absences child

– It is a common form of generalized epilepsy in normal school-age children; peak frequency to 7 years. Female.

– The attacks are very common (10 to 200 / day). Brief break contact (simple or complex) of a few seconds favored by hyperventilation.

– The EEG is characteristic with a beginning and an abrupt end, spikes oven to 3 hertz, regular, symmetrical, bilateral and synchronous.

– Factors under bob prognosis occurred after 8 years, male gender, resistance to treatment, crisis photosensitivity.

* Juvenile Myoclonic Epilepsy

Start between 6 and 25 years; peak frequency between 12 and 17 years. These are myoclonic jerks, symmetrical, bilateral, isolated or repeated, involving the upper limbs and face. They occur on awakening, favored by a sleep debt. Generalized seizures are associated with myoclonus (tonic-clonic seizures). EEG (PO and PPO unbalanced).Photosensitivity is common. myoclonus are preceded PPO complex. This Epilepsy is chemically dependent and stopping the treatment causes a recurrence in 90% of cases.

3- cryptogenic generalized epilepsy:

* Syndrome West (or bending spasm disease)

– They are infantile spasms that occur in infants under 1 year (4th or 7th month).

– Diagnostic Triad: Infant spasm in flexion or extension; arrest of psychomotor development and regression of acquisitions; hypsarrythmia.

– The spasms are bursts 10 to 20 spasms over a period of 10 to 20 minutes occur in change alertness (arousal or sleep)

– EEG pathognomonic (hypsarrythmia): very wide, very slow waves, spikes irregularly, asynchronous, diffuse and permanent; interrupted by spasms during a transient flattening.

– There are symptomatic forms (severe brain injury) more pejorative and more favorable idiopathic forms.

* Lennox-Gastaut Syndrome

– This is one of the most severe forms of childhood epilepsy. Syndrome combines three types of crises: nocturnal tonic; atypical absence, atonic seizures. Mental disorders, mental retardation, personality disorders. It may follow West syndrome.

– The age of onset is before age 8, with peak incidence between 3 and 5 years.

– The combination of tonic and atonic seizures causes traumatic falls, part of the syndrome. Absences are at the beginning and end progressive; the states of non-convulsive evil (status) are common.

– The EEG has a troubled background track, slow wave peaks, wide, low frequency diffuse (2.5 Hz). Fast paced landfills (10 Hz) associated with tonic seizures are characteristic.

– Evolution is severe with intellectual deterioration, personality and behavior disorders.

– The syndrome is symptomatic of congenital or acquired brain injury. It may be idiopathic.

4- symptomatic generalized epilepsies:

* Progressive myoclonic epilepsy

– It is secondary to an evolving broader disease due to abnormal metabolism of complex molecules in the body (mucopolysac-charidoses: Lafora disease, mitochondrial diseases …).

– Tetrad: myoclonus (asynchronous, asymmetrical, segmental) tonic-clonic seizures + + + progressive intellectual deterioration cerebellar and extrapyramidal signs.

– The evolution is characterized by a regression of motor and intellectual acquisitions, moving to a bedridden state and death.

Syndrome Kojevnikow or continuous partial epilepsy is secondary to a specific lesion (vascular, inflammatory, post-traumatic or neoplastic) of rolandic motor cortex. It is characterized by a state of often rebellious focal part poorly to therapy. The evolution depends on the causal lesion.

5- Treatment:

– The active drugs all types of seizures including absences and myoclonus: sodium valproate (Depakine) diazepam and clonazepam.

– The active drugs all absences and myoclonic seizures except carbamazepine; phenytoin (Di-Hydan) => especially partial seizures; generalized tonic-clonic seizures and secondarily generalized seizures.

– The active drugs all types of crises except for absences: phenobarbital (Gardenal)

– Assets of status epilepticus: benzodiazepines (clonazepam: Klonopin); dihydrophénylhydantoïne (Dilantin);Dépakine injection; phenobarbital.