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Diagnosis           Difficulties in Diagnosis        Treatment

 

Diagnosis

This is essentially similar in adult & children. [please refer back to diagnosis in Epilepsy]  

Infants and young children with epilepsy of unknown cause may undergo more complex blood, urine and spinal fluid testing to look for a possible biochemical or genetic basis, especially when seizures are accompanied by delayed development and there is the impression of a deterioration in seizure control.

Although the majority of childhood epilepsies have a genetic (relation to family) component, like other common medical problems (eg. asthma, migraine, diabetes), there is as yet no specific tests to identify these factors. Chromosome tests may be performed in children with epilepsy and delayed development, but it is rare to identify an abnormality with such tests.

Brain imaging to detect damaged brain is not performed routinely in children with epilepsy, as the majority of children with seizures have idiopathic disorders with normal brains. Children with uncontrolled epilepsy sometimes undergo detailed EEG and imaging studies as an inpatient and outpatient to accurately localise the source and determine the cause of their seizures, with a view to specialised treatments.

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Difficulties for accurate diagnosis in young patients:

i) Health care professionals have usually not witnessed the seizure, but are relying upon descriptions from other observers, including parents, baby sitters, and siblings who are in a very distraught state at the sight of the child’s first few seizures. In other circumstances, the seizure type and EEG abnormalities do not agree. This is sometimes due to a sampling phenomenon. Routine EEGs may not demonstrate characteristic abnormalities in between the seizures, or may show findings only in certain times of the day. In a minority of children, even multiple recordings fail to capture these characteristic markers for a likelihood of epileptic susceptibility. 

ii) Even when these abnormalities are captured, their interpretation may be difficult owing to the age of the patient. The organization of normal and abnormal features of the EEG is highly dependent upon the child’s age. Very young children have less synchronization of activity between the two sides of the brain and cannot manifest generalized discharges which are the hallmark of a generalized epilepsy. Instead of manifesting these discharges, the EEGs in children with a generalized form of epilepsy will often show focal or multifocal abnormalities  [which can be mistaken for partial epilepsy] early in life. The absence of generalized spikes can create confusion as to the true identity of the epilepsy. Closed circuit television/electroencephalographic (CCTV/ EEG) recording in a specially equipped inpatient unit is the procedure of choice to aid in these circumstances.

iii) Availability of MRI. MRI, compared to CT, is the neuroimage of choice for children with seizures. The main reason for this is that the lesions seen in children with epilepsy are often subtle and relate more to mild disturbances of cortical formation than to gross destructive lesions with mass effect. In addition, CT scans are prone to bone obscuring large portions of the most epileptogenic (ability to cause epilepsy) portions of the brain: the temporal and inferior frontal lobes. CT is limited to the one side of the patient unless the patient is laboriously re-positioned or computer-assisted reconstructed images are generated. What more, reconstructed CT images lack the clarity and definition of MRI images. In addition, for some subtle abnormalities, to be appreciated, CT must be viewed in the proper plane which makes accurate diagnosis even more difficult. In contrast to the CT, there are many different sequences to use with MR imaging, allowing one to customize the MRI to the clinical problem. These sequences reveal abnormalities that is often undetected on CT. Finally, CT requires ionizing radiation which maybe be risky to health. Even in emergency room visits, CT should play little or no role in the evaluation of the child with new onset epilepsy.

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Treatments

Children with seizures do not always need treatment. In many instances, explanation and reassurance by the doctor and advice about safety precautions and first aid management for possible future seizures is suffice. Many children with epilepsy have only a single seizure and do not require medication. 

For children with recurrent seizures, the decision to prescribe medication depends on the type of seizure disorder, the age of the child, the presence of associated developmental and behavioral problems, and the attitudes and lifestyle of the child and family. Medical treatment usually means prescription of ant-epileptic medication to prevent further seizures but occasionally, medication is prescribed to treat seizures when they manifest. The goal of treatment in pediatric epilepsy is not only to control seizures, but to improve the developmental potential of the child. 

General Treatments include:

Special Treatment [For children with uncontrolled epilepsy] include:

 

Useful link/s:

Ketogenic Diet Packard Children's Hospital

 

 

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