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The author also addresses some of the emotional and social issues that may arise, and there are chapters for kids and teens to read themselves or with their parents. Part 2 covers some of the most common epilepsy syndromes in more detail. Further reading and useful contacts are also provided. This reassuring, informal, and upbeat book will reinforce and help clarify the discussion with the child's treating medical professional. On occasion, a routine EEG might actually happen to capture a seizure. Capturing an actual seizure on the EEG essentially proves a seizure disorder.

In addition to showing the features of seizure disorders, the EEG can also show areas of the brain where the waves are slower, of lower voltage, or less organized than expected. Other times, they are localized and indicate that one part of the brain is functioning abnormally—perhaps due to a structural abnormality. As we shall see in Part 2, certain patterns on the EEG are associated with particular epilepsy syndromes. The location of spikes can help determine if the seizure is generalized the spikes come from everywhere all at once or focal the spikes come from one part of the brain.

In particular, seizures that occur during sleep should best be evaluated with an EEG that includes sleep. In fact, EEGs are generally most likely to detect abnormalities if they include awake, drowsy, and sleeping states: spikes can be activated by sleep deprivation, by the act of falling asleep during the EEG, and by the state of being asleep. In particular, children with benign childhood epilepsy with centrotemporal spikes also known as benign rolandic epilepsy may have totally normal EEGs during the waking state that become markedly abnormal during sleep.

Even young children who will need to be sedated will benefit from sleep deprivation the night before, as the sedative works much better on children who are already sleepy. Sleep deprived EEG.

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In children, we typically allow several hours of sleep; or, simply bring in the child well past naptime. Children should not nap while traveling to the EEG lab! In addition to the above conditions, the patient is given enough time to fall asleep during the EEG. In order to get some children to tolerate multiple wires being glued onto their head, some children will require an oral sedation.

Note that, unlike during an MRI, children do not need to be perfectly still during the EEG although that would be nice. Discuss the issue of sedation for this procedure with your physician. A video camera also records the events. The video EEG is performed when it is essential to actually capture a spell on the EEG in order to determine whether or not it is a seizure. It is also usually part of the evaluation of any possible epilepsy surgery.

If the video picture component is not required for the prolonged study, sometimes it can be done at home with ambulatory equipment. Like the video EEG, an accurate event log is essential. The ambulatory equipment may not be quite as sensitive for some types of seizures as the in-patient monitoring, and does not include a video portion for the doctors to see. Also, some children need the support of the in-patient EEG technicians in order to keep the leads on. If one EEG does not give the required information, repeating the study significantly increases the yield and accuracy of detecting a seizure disorder.

Children With Seizures: A Guide For Parents, Teachers, And Other Professionals

They may also be done to make sure that we are not missing certain undetected seizures. Otherwise, routine follow-up EEGs are usually not required during treatment. Blood tests Blood tests frequently performed in the evaluation of seizures include blood chemistries electrolytes, renal function tests, glucose, calcium, and liver function tests and a complete blood count.

Usually, these can be accomplished from a single blood drawing. What if the tests are all normal? Many parents are somewhat frustrated when we tell them that all of the tests come back normal. They want to know why their child had this event!


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That is good news. Having a normal MRI certainly beats the alternative. The decision to treat with anticonvulsants: What do you need to know? In order to help doctors and families reach appropriate decisions for these children, the American Academy of Neurology in conjunction with the Child Neurology Society reviewed the literature to produce a practice parameter on the treatment of a first, unprovoked seizure Hirtz et al.

Presented below are some of the questions and best available answers found in that review of tonic-clonic or partial seizures. The answers to these questions can help parents and their doctors reach an informed decision regarding how best to care for the child. What potential problems could result from a second seizure? Some animal studies identified in the practice parameter show that prolonged or recurrent seizures may in some situations cause brain cell damage and increase the risk of epilepsy.

A study by Camfield et al. After a first unprovoked seizure, how likely is a single recurrence? Multiple studies reach multiple different conclusions about the risk of a seizure recurrence by one year after the first seizure, with estimates ranging from 14 percent to 65 percent. Freeman et al.

The majority of these recurrences occurred within the first year or two of the first seizure.

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Note that subtle seizures such as absence spells are rarely detected after the first one. Thus, subtle seizures are typically already recurrent when first diagnosed, and typically require treatment. After a first unprovoked seizure, how likely are multiple recurrences?

What are the risk factors of having a recurrence? Not surprisingly, children with an identifiable underlying brain disorder such as an old injury are at a higher risk of recurrence, as are children with an abnormal EEG.

Children with Seizures: A Guide for Parents, Teachers, and Other Prof…

For those children with a first idiopathic seizure, the recurrence risk is 30—50 percent at two-year follow up. For children with a first seizure due to a pre-existing brain problem, the risk is typically greater than 50 percent. However, children who present in status epilepticus are at much higher risk for any possible future recurrences to also be prolonged.

Does anticonvulsant treatment after a first seizure actually work? The practice parameter concludes that the use of anticonvulsants after a first seizure does reduce the risk of recurrence—but, the size of that effect varies between studies, and the data from pediatric studies is not strong. Available data also provides good evidence that waiting to start treatment until after the second seizure does not reduce the chance of obtaining a one to two-year reprise from the seizures. To treat or not to treat: Individualizing the decision So, how do we put this all together? The decision to treat children with one or more seizures with anticonvulsants is made jointly by family members and their doctors.

In general, most neurologists do not suggest anticonvulsants to children after a first, generalized, brief seizure in the setting of a normal EEG and MRI. However, the care for each child must be individualized, taking into account the risks of seizures vs. See Part 2 for treatment decisions for individual epilepsy syndromes. Typically, children are treated with anticonvulsants until they have gone two consecutive years without a seizure.

As always, individualization is key. At the time that tapering is considered, the EEG is repeated, and consideration with the family is given to tapering off the anticonvulsant over a several month period. Sudden discontinuation of certain anticonvulsants might trigger an exacerbation of severe seizures. Risk factors for a relapse after discontinuing anticonvulsants include: difficulty obtaining seizure control initially, the presence of partial seizures, the first seizure starting after 12 years of age, neurological or developmental abnormalities in the child, and an abnormal EEG at time of discontinuation.

Examples of children in this category include those with Juvenile Myoclonic Epilepsy or Lennox—Gastaut syndrome. If there are relapses, half will occur within the first year of discontinuation of medication, and almost all relapses occur within the first two years of discontinuation Freeman et al. If the child relapses after a first attempt at tapering the anticonvulsants, we might try it again in a few more years. Stopping the anticonvulsants: The emotional aspects Understandably, parents and children often have mixed feelings about tapering the anticonvulsants. On the one hand, it is an exciting prospect to get this problem behind us.

To address these concerns, consider the following advice.