विवरण
Pediatric epilepsy is a neurological disorder marked by recurrent seizures, affecting around 1% of children worldwide. Early and accurate diagnosis is crucial for effective management, involving a thorough clinical history, physical exams, EEG, and imaging studies like MRI. Identifying seizure type and underlying causes—such as genetic, structural, or metabolic factors—guides treatment strategies. Long-term management typically includes antiepileptic medications tailored to seizure type and child response, with regular monitoring for side effects and efficacy. For medication-resistant cases, additional treatments like dietary therapy (e.g., ketogenic diet), vagus nerve stimulation, or surgery may be explored. Beyond seizure control, managing comorbidities such as cognitive delays, behavioral issues, and psychosocial challenges is essential for holistic care. Collaborating closely with healthcare providers, caregivers play a key role in monitoring, ensuring adherence, and supporting the child’s quality of life, education, and social integration.
सारांश
- Seizures in children are common and require careful diagnosis, counseling, and management. The brain's anatomy, particularly the frontal, parietal, occipital, and temporal lobes, is crucial for understanding seizure localization. Key terms include seizures (transient signs/symptoms due to abnormal neuronal activity), epilepsy (two unprovoked seizures more than 24 hours apart or one seizure with high recurrence probability), and status epilepticus (seizure lasting over five minutes).
- Seizures are classified as generalized (involving both hemispheres, often with loss of consciousness) or focal/local (affecting a specific brain area, potentially without loss of consciousness). Convulsions involve motor activity, while non-convulsive seizures show abnormal EEG activity without obvious motor components. Status epilepticus can cause physiological brain damage and future complications.
- The pathophysiology involves abnormal electrical cortical discharges due to partial neuron depolarization. Biochemical factors include GABA deficits and glutamate receptor changes. The International League Against Epilepsy (ILAE) provides updated classifications, distinguishing focal, generalized, and unknown onset seizures. Understanding aetiology is essential, as 70-80% of seizures have unknown causes, especially considering age-specific presentations.
- Neonatal seizures may indicate cerebral malformations or congenital infections, while neurodegenerative disorders can emerge later. Inborn errors of metabolism are common in infancy. Non-epileptic conditions like metabolic derangements can trigger seizures. Evaluation includes detailed history, physical/neurological examination, EEG, and neuroimaging to identify treatable causes.
- Management focuses on complete seizure control without significant side effects. Acute care involves safety measures at home (lateral position, clear surroundings) and hospital interventions (ABC, blood tests, lorazepam or diazepam). Long-term management involves careful anti-epileptic drug selection, starting with low doses and gradually increasing.
- Special conditions like infantile spasms and Lennox-Gastaut syndrome require specific treatments. The benign rolandic epilepsy remits by adulthood. Certain situations (focal seizures, status epilepticus, neurological deficits) necessitate starting anti-epileptic drugs after a first unprovoked seizure.
- Medication dosage, potential side effects, and the use of monotherapy versus polypharmacy must be carefully considered. Withdrawal can be attempted after two to three seizure-free years. Refractory cases may require epilepsy surgery, ketogenic diet, or other advanced therapies. Long-term follow-up addresses developmental and behavioral problems, ensuring a safe school environment and parental education.
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