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This document discusses epilepsy, including definitions of seizures and status epilepticus. It describes the International League Against Epilepsy (ILAE) classification of seizures into four main types: focal, generalized, epileptic spasms, and those impacted by age. It covers the epidemiology, etiology, clinical characteristics, considerations for starting anti-seizure medication, selection of medications, and guidelines for stopping medication.
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Bahan diskusi epilesi pada anak diambil dari uptodate
This document discusses epilepsy, including definitions of seizures and status epilepticus. It describes the International League Against Epilepsy (ILAE) classification of seizures into four main types: focal, generalized, epileptic spasms, and those impacted by age. It covers the epidemiology, etiology, clinical characteristics, considerations for starting anti-seizure medication, selection of medications, and guidelines for stopping medication.
This document discusses epilepsy, including definitions of seizures and status epilepticus. It describes the International League Against Epilepsy (ILAE) classification of seizures into four main types: focal, generalized, epileptic spasms, and those impacted by age. It covers the epidemiology, etiology, clinical characteristics, considerations for starting anti-seizure medication, selection of medications, and guidelines for stopping medication.
18105 Seizure • Definition : “A seizure represents the clinical expression of abnormal, excessive, synchronous discharges of neurons residing primarily in the cerebral cortex”
• When the seizure is prolonged or immediately recurrent without
a return of consciousness, this is status epilepticus. Epilepsy Types of Seizures ILAE classified seizures into 4 types based on clinical and EEG data: • Focal (partial) seizures : limited to one hemisphere, discretely localized or more widely distributed, may or may not be associated with impairment of awarenesss during attack (simple vs complex partial seizure). Subtype: motor, sensory, autonomic, focal without impairment of awareness, focal with impairment of awareness. • Generalized seizure : both hemisphere, awareness may be impaired as initial manifestation, motor manifestation are bilateral, can have motor manifestation or may be absence. • Epileptic spasm : infantile spasm that involve spasm of muscles of neck, trunk and extremities. There is insufficient knowledge about the mode of seizure onset to categorize spasm a focal/generalized and they are considered of unknown type by ILAE 2017 • Impact of age : Typical generalized tonic-clonic and absence seizures are extremely uncommon in the first two years of life and never occur in the newborn. These issues, unique to the child between two months and two years, have prompted proposals for classifications specifically directed to this age group. Epidemiology • Incidence of epilepsy is 0.5-8 per 1000 person per years • 3-5% will have febrile seizure in first five years of life and 30% will have additional febrile seizure. 3-6% of those febrile seizure will develop afebrile seizures or epilepsy. • Male > female • Partial > generalized seizure Etiology • Genetic • Structural or metabolic : can be caused by transient disruption such as high fever, hypocalcemia, hyponatremia, minor head trauma (concussion), bleeding, ischemia, inflammatory excitation such as meningitis, encephalitis, sepsis, etc or chronic disturbance such as perinatal asphyxia, tumor or neurodegenerative disease. • Neurodevelopmental lessions Clinical Characteristics • Stereotyped (each one is like the previous one) • Random (occur at any time of the day or night) • Rarely precipitated by specific environmental, psychological or physiological events • Some individuals have several different types of seizures • Exceptions: some individuals have seizures only during sleep, others only upon awakening in the morning, others always at the time of menstruation (catamenial seizures), and some following specific stimuli such as certain sounds, flashing lights, stubbing the foot, or being tapped on the shoulder (reflex seizures). The latter seizures (sensory provoked) are rare, but uncovering this information may allow the clinician to classify the child as having a specific epileptic syndrome and develop specific therapy (eg, special glasses with filtered lenses for visually-provoked seizures) When to Start Antiseizure Drug Therapy • First-time unprovoked seizure: risk for recurrent seizures, effect of early versus deferred therapy • Second unprovoked seizure : usually get antiseizure drug therapy since seizure recurrence indicates that the patient has a substantially increased risk for additional seizures (epilepsy). Exceptions if parents choose to no antiseizure drugs if the seizure infrequent and/or mild (subjectively). By contrast, children with absence/atonic seizure always treated because usually present to clinician with established pattern of frequent seizure. • Acute symptomatic seizure: have low risk of recurrence unless the underlying etiology recurs. • Febrile seizure : AAP concludes that neither continuous nor intermittent anticonvulsice therapy is recommended for children with one or more simple febrile seizure. Selection of an Antiseizure Drug • Single-drug therapy is the goal of treatment • Seizure type-related consideration: Corticotropin (ACTH) for infantile spasm, Valproate for absence and juvenile myoclonic epilepsy, broad-spectrum antiseizure for generalized epilepsy syndromes (narrow-spectrum can worsen the seizure), carbamazepine and phenytoin can worsen absence and myoclonic seizure • Choose that require only once-twice daily and allow for make-up dosing • Look for the side effect of each drugs choosen • Teratogenicity: valproic acid can increase risk of spina bifida for the baby in pregnant women Stopping Antiseizure Drug Therapy • Withdrawal antiseizure drug should be considered in most children after 2 years without seizures regardless of the etiology. Risk of recurrence after 2 years without seizure is 30- 40% • Tapering off in several weeks to few months are generally recommended TERIMA KASIH Mohon asupan