Epilepsy Secrets in Childhood

1. Dr:
Samir M Mounir
Lecturer of Neuropediatrics
Minia University

3. ‫اء‬‫ر‬‫س‬‫لا‬‫ا‬‫ورة‬‫س‬.‫ة‬‫ي‬‫ا‬85

4. 1
•Knowledge
2
•Practice
3
•Service

5. 1- So Ancient
2- Misunderstood
3- Still Stigmatized
4- More prevalent
5- More Tragedy
6- worthy
7- Deceptive
8- Underdiagnosed
9- Ambiguous
10- Learning is the key answer

6. 1-Ancient

7. Since beginning of recorded history
The oldest description in a text in Akkadian (2000 BC)
Code of Hammurabi (c. 1790 BC)
Edwin Smith Papyrus (c. 1700 BC)
Holly Sunnah

8. Avicenna (980–1037)

9. Prince of Doctors
The first person to coin the
term “epilepsy”, using a
passive Latin verb. In his
Canon of Medicine
Epilepsy in the WHO Eastern
Mediterranean Region: bridging the WHO:
ISBN: 978-92-9021-696-4

11. Misconceptions, blame, and discrimination to both
patient and families.
Contagious.
Literary works, films and TV series which mark the
awareness and knowledge, often relate it with madness,
evil, violent behaviors or possession by the divine or
ghosts.
Although a revolution has been done in epilepsy
research, it didn’t make a paradigm shift in perception
and understanding of epilepsy in general population.

14. Code of Hammurabi: a purchased slave may be returned
for a refund
Ancient Rome people did not eat or drink with epileptics
Germany, in 1934 by Law for the Prevention of Offspring
with Hereditary Diseases including epilepsy, compulsory
sterilization and extermination was done.
Epileptics were the victims of eugenic sterilization
programs in Sweden (1935–1975), many states of the
USA (until 1956), and were not allowed to marry (in the
UK until 1970).

15. 8%

16. 40% have experienced
discrimination or exclusion from
peers
41% told they are sick
43% called mad or crazy
29% told that epilepsy is
contagious
20% accused of being possessed
18% asked if they can speak to
spirits

19. One of the most common neurological disorders with no
geographical, racial or social boundaries. It can begin at any
age
50 million worldwide (all ages)
4.7 million live in the Eastern Mediterrnean Region.
More in youngers
In Egypt, the prevalence was 6.98 / 1000 (Hamdy etal .,
2009)
70% of epileptic children outgrow it

20. Pediatric epilepsy may cause changes in the development of the
brain.
It has serious physical, psychological and social impact is most
severe in children and adolescents

22. Wei SH, Lee WT. Comorbidity of childhood epilepsy. J Formos Med Assoc.
2015;114(11):1031–1038

23. Be generous in giving time and efforts: it deserves
Nothing more precious than HISTORY
Also, General Exam; dermatologic abnormalities (eg,
neurocutaneous syndromes such as Sturge-Weber,
tuberous sclerosis, and others), HC, Dysmorphology,

25. Focal epilepsy in childhood is often associated with age-
specific etiologies.
Jayalakshmi et al. Surgery for childhood epilepsy. Ann Indian Acad Neurol. 2014;17(Suppl 1):S69–S79.
Seizure semiology varies by age, and the ictal EEG
pattern may be less clear cut than what is seen in adults.
Nickels KC et al. Temporal lobe epilepsy in children. Epilepsy Res Treat. 2012;2012:849540.
Most of the focal epilepsies are either structural or
unknown, which means there is a supposed focal
structural cause that cannot be identified historically or
be seen with current imaging techniques.

27. Side effects:
Disease or drugs?
Different from adults
Variable even in children
Drowsiness, sleep disorders, dizziness or stomach upset and mood
swings
Cognition, learning, concentration, attention and memory
Behavior problems, including hyperactivity or irritability
Seizures
Dangerous reactions such as hypersensitivity (allergy) or liver
failure
Interactions between AEDs and other medications
Food drug interaction
Other indications

29. Pharmacoresistant epilepsy: The ILAE defines as the
failure of a patient’s seizures to respond to at least two
antiepileptic medications that are appropriately chosen
and used for an adequate period
Paradigm shift ( Cause and management)
Neurogenetics
Neurometabolics
Neurodevelopmental ( Mental and Behavioral)
Neuroinflammation
Neuroimmunity

31. Some epileptic syndromes begin in neonatal period:
1-Benign Familial Neonatal Epilepsy
2- Ohtahara Syndrome
3-Early Myoclonic Encephalopathy
4-KCNQ2 Encephalopathy
5-Vitamin-responsive Epilepsies:
Pyridoxine-dependent seizures
Pyridoxal-phosphate-dependent seizures
Folinic acid-responsive seizures
Biotinidase deficiency
Electro-clinical dissociation phenomenon: seizures can be
electroclinical, electrographic (subclinical) or clinical only
Electrographic seizures are ‘electrical only seizures, clinically silent ,
defined as a sudden, repetitive, evolving and stereotyped event of
abnormal electrographic pattern with amplitude of at least 2 microvolts
and a minimum duration of 10 seconds.

33. Febrile seizures
Effects of prolonged febrile seizures on neuronal structure and function
Febrile Status Epilepticus
Epilepsy: The risk of future epilepsy in children with complex febrile
seizures is around 4–6%
Generalized epilepsy with febrile seizure plus (GEFS+)
Hippocampal Sclerosis
Dravet syndrome
.

34. Presentation and type

35. Myoclonic
Gelastic
Hyperkinetic
Hypomotor and behavioral arrest
Absence
Reflex epilepsy

36. 1. At least two unprovoked (or
reflex) seizures occurring >
24h apart
2. One unprovoked (or reflex)
seizure and a probability of
further seizures ,,,,,,,,,,,,,,,,,,,

37. EEG Tragedy
Conditions mimic epilepsy
Neuropsychiatry overlap
Neuroendocrine bond

38. “30% of patients seen at epilepsy centers for refractory seizures do not epilepsy”
10% of normal people may have non-specific EEG abnormalities and
approximately 1% may have ‘epileptiform paroxysmal activity’ without seizures.
The prevalence of these abnormalities is higher in children, with 2–4% having
functional spike discharges.
Panayiotopoulos CP. The Epilepsies: Seizures, Syndromes and Management. Oxfordshire (UK): Bladon Medical Publishing;
2005. Chapter 2, Optimal Use of the EEG in the Diagnosis and Management of Epilepsies.

40. Conditions mimic epilepsy
Hypereklepexia
Benign myoclonus of infancy
Sandiffier Syndrome
Shuddering
Breath holding attacks
Non epileptic seizure
Migraine
Masturbation
Syncope
Sleep disorders and Parasomias
Pseudoseizures
Teeth grinding
scabies

42. It is not always an easy task to correctly diagnose
epilepsy and a recent UK study has shown misdiagnosis
of the condition was as high as 22%, other studies
have found a misdiagnosis rate of between 10% and
30%.
PNES is a psychiatric disorder; it is a conversion
disorder, which falls under the diagnostic category of
somatic symptom disorders in the Diagnostic and
Statistical Manual of Mental Disorders, Fifth Edition
(DSM-5).