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:
|
Treatment |
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|
DCI |
® |
Dosage |
Indications |
||
| Diazepam (DZP) | Valium | 0.5 mg / kg rectally … | Treatment of urgent crisis | Benzodiazepine | |
| Carbamazepine (CBZ) | Tegretol | 10 to 20 mg / kg (per os) | Partial Epilepsy (idiopathic or 2aire) | Stabilizes the neuro membrane | |
| Valproic acid (VPA) | Dépakine | 30 mg / kg / day (per os) | Generalized epilepsy (idiopathic or 2aire) | Stimulates potassium channels | |
| Vigabatrin (VGB) | Sabril | 50 mg / kg / day (per os) | Infantile spasm; resistant partial epilepsy | Inhibits GABA transaminase | |
| Ethosuximide | Zarontin | Active absences (but this information is restricted because of its
2aires effects) |
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– 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.