Diagnosis Of Epilepsy In Children Research Articles

The Utility of 24-h Video-EEG Monitoring in the Diagnosis of Epilepsy in Children

The Utility of 24-h Video-EEG Monitoring in the Diagnosis of Epilepsy in Children

Preliminary development and validation of the Indonesian Pediatric Epilepsy Questionnaire (INA-PEPSI) to determine epilepsy and distinguish focal and generalized epilepsy in infants and children with unprovoked seizure in low-resource settings.

To outline the preliminary development and validation of a questionnaire for diagnosing epilepsy and distinguishing focal and generalized epilepsy among infants and children in Indonesia, where electroencephalography and pediatric neurologists are generally not available. A 10-question questionnaire comprising of 43 items was developed through literature review and expert panel discussions. Then, the questionnaire was administered by pediatricians to 75 children aged 1 month to 18 years old presenting with >1 episode of unprovoked seizures at an interval of >24 h. Subsequently, the questionnaire was assessed for content validity with item-level and scale-level content validity indices and ratio, construct validity with item-total correlation tests, criterion validity with diagnostic parameter assessments, and inter-rater reliability using Cohen's kappa (κ) and internal consistency with Cronbach's alpha (α) coefficient. The questionnaire exhibited favorable internal validity and reliability in diagnosing epilepsy and distinguishing focal and generalized epilepsy, with excellent content (both indices and ratio at 1) and construct validity (rcount > rtable at p < 0.001), inter-rater reliability (κ = 0.86 and κ = 0.84), and internal consistency (α = 0.634 and α = 0.806). The questionnaire had a sensitivity and specificity of 96.4% (95%CI 89.1-99.5%) and 95.0% (79.5-99.6%) (area under the curve [AUC] 0.946 [0.900-0.992, p < 0.001]) in diagnosing epilepsy and 80.0% (57.4-95.7%) and 97.4% (89.7-99.2%) (AUC 0.889 [0.783-0.995, p < 0.001]) in distinguishing focal and generalized epilepsy, with a misdiagnosis rate of 4.0%. The questionnaire shows promising potential in diagnosing epilepsy and distinguishing focal and generalized epilepsy. Further external validation studies in larger and more diverse populations are required to confirm our findings. The diagnosis of epilepsy in children is challenging, particularly in resource-limited settings such as Indonesia, where advanced diagnostic tests and pediatric neurologists are scarce. The Indonesian Pediatric Epilepsy Questionnaire (INA-PEPSI) is designed to address these limitations by enabling healthcare professionals in Indonesia to diagnose epilepsy and classify its types without relying on advanced diagnostic tools. Although the questionnaire is still in the early stages of development and validation, this study demonstrates that the questionnaire exhibits good overall diagnostic performance in diagnosing epilepsy and distinguishing epilepsy types among Indonesian children.

Contribution of the sleep electroencephalogram in the diagnosis of epilepsy in children at the Ibrahima Pierre Ndiaye Neurological Clinic of Dakar, Senegal

Contribution of the sleep electroencephalogram in the diagnosis of epilepsy in children at the Ibrahima Pierre Ndiaye Neurological Clinic of Dakar, Senegal

TO CORRELATE CLINICAL FEATURES WITH EEG FINDINGS AND NEUROIMAGING (MRI) ABNORMALITIES IN CHILDREN WITH SEIZURE DISORDER

Objectives: To evaluate the ndings of EEG and MRI in childhood seizure disorder, and to determine correlation between clinical features, EEG ndings and neuroimaging (MRI) abnormalities in children with seizure disorder. Methods: The present study was carried out in the department of Pediatrics in active collaboration with department of Radiodiagnosis, Maharani Laxmi Bai Medical College, Jhansi over a period of one year from june 2019 to june 2020. Children of 1 month to 15 years of age attending in OPD for follow up or admitted in pediatric wards were selected for this study. All patients underwent EEG and MRI. Our study group comprised of 70 cases of epilepsy, Among which 45 were male and 25 were female. The correlation between MRI and EEG abnormal ndings was analyzed using chi-square test. Result: Out of 70 cases, 45 cases were male and 25 cases were female. 52.85% cases had generalized seizure and 47.14% cases had partial seizure. Out of 70 cases, 50 cases had structural lesions, 4 cases had metabolic problem, 9 cases had fever and 7 cases had idiopathic etiology. 57.14% cases had abnormal MRI ndings. MRI abnormality present was ventricular abnormalities (22.85%), white matter lesion (14.28%), brain stem and cerebellar abnormalities (11.42%), cortical lesion (grey matter) (8.57%), deep grey matter (7.14%) and miscellaneous (2.85%). Out of 70 cases 44 cases had EEG abnormality. Out of 70 cases, 13 had normal MRI with normal EEG, 17 had normal MRI with abnormal EEG, 13 had abnormal MRI with normal EEG and 27 had abnormal MRI with abnormal EEG. The correlation between abnormal EEG and abnormal MRI was statistically not signicant (p=0.35). Conclusion: Our study reveals that both EEG and MRI are important tools in diagnosis of epilepsy in children and MRI is specially important to diagnose structural lesions in symptomatic epilepsy. In our study no signicant correlation was found between abnormal EEG and abnormal MRI ndings

Study of electroencephalogram characteristics in neurological conditions in pediatric tertiary care hospital

Background: Electroencephalogram (EEG) remains a veritable tool in the diagnostic workup of seizures and childhood epileptic syndromes. EEG has a significant role in substantiating the clinical suspicion of epilepsy, the classification of seizures, and the management of childhood epilepsy. Methods: This study was retrospective descriptive with convenience sampling where two-years EEG recordings were included and the reporting were reviewed. The desired variables were encrypted and descriptive analysis made via statistical software SPSS version 20. Results: There was 499 EEG done in a two-year time period where the female children were (n=205, 41.1%) and mean age was 66 months. There were (n=317, 63.5%) children from out of Kathmandu valley. The most common indication for EEG recommendation was seizure without impaired consciousness (69.7%) and least common indication was seizure with impaired consciousness (8.4%). The rate of detection of EEG abnormalities in seizure without impaired consciousness was 43.9% while that in seizure with impaired consciousness was 38.1%. Among the most common EEG abnormality, abnormal sleep EEG record suggestive of generalized epilepsy most of the children had a history of seizure without impaired consciousness (71.4%) and least presented with seizure with impaired consciousness. Conclusions: The abnormality detection rate of epilepsy was higher in chance if done in early ages. The possibility of findings in EEG are higher with the history of seizures and the perinatal insult as well as birth asphyxia. EEG should be carried out to support the diagnosis of epilepsy in children, and a normal EEG won't be totally excluding epilepsy.

The Importance of Long-Term Video Electroencephalography Monitoring in the Differential Diagnosis of Epilepsy in Children.

Objective: Epilepsy is a condition in which abnormal, recurring, and excessive neuronal discharges caused by many different disorders in the central nervous system are observed. The rate of detecting epileptiform activity in the first interictal electroencephalography (EEG) of patients with epilepsy is around 40%, even when routine activation methods are applied. Video recordings simultaneously with EEG recordings enable the establishment of correlations between abnormalities.Patients and methods: The long-term video-EEG monitoring (VEM) reports and images of 87 patients hospitalized in the video EEG service in the Pediatric Neurology Clinic of İnönü University between 2016 and 2020 were retrospectively analyzed in this study. Demographic information of the patients, such as age, gender, diagnosis/history, and length of hospital stay, was analyzed.Results: A total of 87 patients were included in the study. Of the patients, 54 (62.1%) were male and 33 (37.9%) were female. The mean age was 107.57 ± 64.40 months. While 10 (11.5%) patients followed up with non-epileptic paroxysmal events (NEPE) were taking antiepileptic drugs (AEDs), AED treatments were discontinued after VEM. The diagnosis of 18 (20.69%) patients changed after VEM. The medications of 27 (31%) patients who took AEDs before VEM were discontinued after VEM. During VEM, sleep movement, psychogenic seizures, infantile masturbation, and tic disorder were observed in 19 (41.3%), 17 (36.9%), three (6.5%), and three (6.5%) patients, respectively.Conclusion: In conclusion, VEM is the gold standard diagnostic method used to distinguish between epilepsy and NEPEs. After VEM, the clinical diagnosis of patients can change, and unnecessary drug administration may be prevented. Psychogenic nonepileptic seizures and NEPEs are common in the pediatric population; however, they are often overlooked.

Role of Mri In The Diagnosis Of Epilepsy In Children

Role of Mri In The Diagnosis Of Epilepsy In Children

A children’s epilepsy diagnosis aid: Development and early validation using a Bayesian approach

IntroductionThe diagnosis of epilepsy in children is difficult and misdiagnosis rates can be as much as 36%. Diagnosis in all countries is essentially clinical, based on asking a series of questions and interpreting the answers. Doctors experienced enough to do this are either scarce or absent in very many parts of the world so there is a need to develop a diagnostic aid to help less-experienced doctors or non-physician health workers (NPHWs) do this. We used a Bayesian approach to determine the most useful questions to ask based on their likelihood ratios (LR), and incorporated these into a Children’s Epilepsy Diagnosis Aid (CEDA). MethodsNinety-six consecutive new referrals with possible epilepsy aged under 10 years attending a pediatric neurology clinic in Khartoum were included. Initially, their caregivers were asked 65 yes/no questions by a medical officer, then seen by pediatric neurologist and the diagnosis of epilepsy (E), not epilepsy (N), or uncertain (U) was made. The LR was calculated and then we selected the variables with the highest and lowest LRs which are the most informative at differentiating epilepsy from non-epilepsy. An algorithm, (CEDA), based on the most informative questions was constructed and tested on a new sample of 47 consecutive patients with a first attendance of possible epilepsy. We calculated the sensitivity and specificity for CEDA in the diagnosis of epilepsy. ResultsSixty-nine (79%) had epilepsy and 18 (21%) non-epilepsy giving pre-test odds of having epilepsy of 3.83. Eleven variables with the most informative LRs formed the diagnostic aid (CEDA). The pre-test odds and algorithm were used to determine the probability of epilepsy diagnosis in a subsequent sample of 47 patients. There were 36 patients with epilepsy and 11 with nonepileptic conditions. The sensitivity of CEDA was 100% with specificity of 97% and misdiagnosis 8.3%. ConclusionChildren’s Epilepsy Diagnosis Aid has the potential to improve pediatric epilepsy diagnosis and therefore management and is particularly likely to be useful in the many situations where access to epilepsy specialists is limited. The algorithm can be presented as a smartphone application or used as a spreadsheet on a computer.

Massive parallel DNA sequencing for the diagnosis of drug-resistant epilepsy in children

Massive parallel DNA sequencing for the diagnosis of drug-resistant epilepsy in children

Significance of exome sequencing for diagnosis of epilepsy in children

Introduction . Epilepsy is a neurological disorder characterized by periodic seizure attacks. Around 70–80% of epilepsy cases have a hereditary component. Aim : to identify the genetic factors of pharmacoresistant epilepsy in children. Materials and methods . Fifty two patients with epilepsy and psychomotor / speech retardation were examined. We used the next generation sequencing (NGS) technique, which is the targeted exome sequencing, the “Hereditary epilepsy” panel of genes, and the whole exome sequencing assay. Results . Mutations were detected in 30 (57.7%) patients, while 22 patients had no mutations. In the latter cases, either epilepsy was of non-hereditary nature or the tested nucleotide sequence was located in the non-coding part of the gene (intron); in addition, a chromosomal rearrangement could be involved. Conclusion . The obtained data illustrate a diagnostic significance of the whole exome sequencing and encourage the interaction between an epileptologist and a geneticist in the diagnostic procedure. Identification of the genetic base of the disease is of great importance for genetic counseling and for selecting an antiepileptic therapy in this group of patients. The authors declare about the absence of conflict of interest with respect to this publication. Authors contributed equally to this article.

Evaluation of serum matrix metalloproteinase-9 as a potential biomarker for diagnosis of epilepsy in children

Introduction Epilepsy is a common serious neurological disorder. Medical histories and electroencephalogram are not always sufficient for epilepsy diagnosis; therefore, exploring the novel methods for the accurate diagnosis of epilepsy is of great importance. Matrix metalloproteinase (MMP) are vital drivers of synaptic remodeling in health and disease. It plays a well described role in neuroinflammation; it is suggested that at early stages of epileptogenesis, inhibition of MMP may help ameliorate cell death, aberrant network rewiring, and neuroinflammation and prevent development of epilepsy. Aim MMPs especially MMP-9 and MMP-2 are sensitive to seizures; thus, MMP-9 may be a potential biomarker for epilepsy diagnosis, we assessed MMP-9 levels in the context of its possible use as a biomarker of the activity and diagnosis of epilepsy and evaluation of the nutritional state by anthropometric measurement. Patients and methods Thirty epileptic patients aged from 4 to 17 years, selected randomly from the inpatient and outpatient neurological unit of pediatric department in Alzhraa University Hospital between 2018 and 2019 were subjected to: etailed medical history, general and neurological examination, routine laboratory studies, electroencephalogram, anthropometric measurement, and serum MMP-9 level measurement. Thirty age-matched and sex-matched healthy controls were selected and their serum MMP-9 and anthropometric measurements were obtained. Results Serum MMP-9 levels were statistically significantly high in patients with idiopathic epilepsy compared with the control group. Sensitivity of MMP-9 as biomarkers was 62.07% with 96.67% specificity. The cutoff point of MMP-9 more than 4. Conclusion MMP-9 levels increased in patients with epilepsy. This tool may be a helpful diagnostic biomarker for epilepsy with good sensitivity and specificity.

To EEG or not EEG

Abstract A routine or standard Electroencephalography (EEG) study is frequently requested by paediatricians to aid diagnosis of epilepsy in children presenting with episodic behaviours. EEG study in children is significantly more sensitive if it includes a period of sleep. It is a valuable investigation provided it is considered in the context of good clinical history and interpreted with familiarity of the range of episodic behaviours in childhood, and the prevalence of incidental epileptiform abnormalities in children with or without neurodevelopmental abnormalities. NICE guidelines emphasise the importance of not relying on EEG in isolation for diagnosis, the main indication for EEG, to define the seizure type and syndrome to guide treatment and prognosis. EEG is also essential when non convulsive status sate or the development of Continuous Spike Wave in Slow Wave Sleep (CSWS) is suspected, but should not be requested in children with autistic regression. EEG should not be included in work up of developmentally/neurologically normal children with simple or complex febrile seizures, and repeat EEG's once the epilepsy seizure type/syndrome has been diagnosed, are of limited value for monitoring treatment or deciding drug withdrawal. The value of a routine EEG can be enhanced by the paediatrician closely liaising with the EEG department to try and record episodes if there are known triggers for the episodes under investigation. This article describes the value of EEG interictal in children and offers advice to those requesting this important investigation.

Diagnosis and management of the epilepsies in children

There are many different types of epilepsy that can occur in childhood, therefore identification and management can be complex. Here, the authors discuss the diagnosis of epilepsy in children, choice of antiepileptic drug treatments and their adverse effects, and non‐pharmacological treatment options.

Use of epilepsy gene panels for early diagnosis of epilepsy in children 2-4 years of age: expert considerations on current and future practices in Europe

Pseudoaneurysm of below-the-knee arteries after a high tibial osteotomy (HTO) is rare. A 69-year-old woman with history of right HTO a half year ago had performed a left HTO for osteoarthritis. Postoperatively, she had swelling and pain of the left lower leg. Computed tomography and echocardiography revealed the pseudoaneurysm of peroneal artery (PA). After the release of the covered stent graft, the pseudoaneurysm of the PA did not disappear, it was completely excluded in the completion angiogram.

Health-related quality of life in mothers of children with epilepsy: 10years after diagnosis.

Epilepsy in childhood extends far beyond seizures and affects child and parental well-being. The long-term impact of childhood-onset epilepsy on parental well-being is unknown. This study assessed health-related quality of life (HRQOL) in mothers 10 years after their child's diagnosis of epilepsy. Data come from the Health-Related Quality of Life in Children with Epilepsy Study, a multicenter prospective cohort study of children with newly diagnosed epilepsy. Mothers completed a mailed questionnaire at the 10-year follow-up, which included the Short-Form Health Survey (SF-12-v2) to evaluate the physical and mental health components of their HRQOL. Block-wise linear regressions identified child/epilepsy, maternal/family, and maternal psychosocial factors associated with mothers' HRQOL. A total of 159 mothers participated in this study (46% of the sample assessed at baseline). At follow-up, 69% of youth had been seizure free for the past 5 years. Mothers scored similarly to population norms (mean: 50, SD: 10) on the mental health subscale (mean: 49.5, SD: 9.3) and significantly better on the physical health subscale (mean: 53.0, SD: 7.6). Better family resources were associated with higher (better) scores on the physical health subscale (B = 0.20; 95% CI 0.03, 0.36). Better family functioning (B = 0.34; 95% CI 0.06, 0.62), fewer maternal depressive symptoms (B = 0.33; 95% CI 0.20, 0.47), and perception of less stress (B = 0.70; 95% CI 0.52, 0.88) were associated with higher (better) scores on the mental health subscale. Ten years after the diagnosis of epilepsy in children, the HRQOL of mothers was similar to reports from women in the general population. This study identified factors contributing to better maternal HRQOL and highlights the importance of family environment over epilepsy-related variables.

Multivariate trajectories across multiple domains of health-related quality of life in children with new-onset epilepsy

The diagnosis of epilepsy in children is known to impact the trajectory of their health-related quality of life (HRQOL) over time. However, there is limited knowledge about variations in longitudinal trajectories across multiple domains of HRQOL. This study aims to characterize the heterogeneity in HRQOL trajectories across multiple HRQOL domains and to evaluate predictors of differences among the identified trajectory groups in children with new-onset epilepsy. Data were obtained from the Health Related Quality of Life in Children with Epilepsy Study (HERQULES), a prospective multi-center study of 373 children newly diagnosed with new-onset epilepsy who were followed up over 2years. Child HRQOL and family factors were reported by parents, and clinical characteristics were reported by neurologists. Group-based multi-trajectory modeling was adopted to characterize longitudinal trajectories of HRQOL as measured by the individual domains of cognitive, emotional, physical, and social functioning in the 55-item Quality of Life in Childhood Epilepsy Questionnaire (QOLCE-55). Multinomial logistic regression was used to assess potential factors that explain differences among the identified latent trajectory groups. Three distinct HRQOL trajectory subgroups were identified in children with new-onset epilepsy based on HRQOL scores: “High” (44.7%), “Intermediate” (37.0%), and “Low” (18.3%). While most trajectory groups exhibited increasing scores over time on physical and social domains, both flat and declining trajectories were noted on emotional and cognitive domains. Less severe epilepsy, an absence of cognitive and behavioral problems, lower parental depression scores, better family functioning, and fewer family demands were associated with a “Higher” or “Intermediate” HRQOL trajectory. The course of HRQOL over time in children with new-onset epilepsy appears to follow one of three different trajectories. Addressing the clinical and psychosocial determinants identified for each pattern can help clinicians provide more targeted care to these children and their families.

Usefulness of Electroencephalography after Partial Sleep Deprivation for the Diagnosis of Epilepsy in Children

Usefulness of Electroencephalography after Partial Sleep Deprivation for the Diagnosis of Epilepsy in Children

Effect of reducing the recording time of standard EEGs on the detection of EEG-abnormalities in the management of the epilepsies of childhood

PurposeThe ILAE recommends baseline recordings of 30min to detect abnormalities supporting a clinical diagnosis of epilepsy in children. A shorter recording time may be better tolerated by children and be more resource-efficient. Our aim was to determine how many abnormalities supporting a diagnosis of epilepsy would be missed by reducing the recording time of paediatric standard electroencephalograms (EEGs) from 20 to 15min. MethodsWe evaluated standard EEGs of 300 patients aged 2 months to 17 years referred consecutively with confirmed or suspected epilepsy. EEGs were recorded for 20min on digital media. A digital copy of each EEG was truncated to give consecutive sequences of 10min (sequence “A”) and 5min duration (sequences “B” and “C” respectively). A panel of EEG raters blinded to the children's’ details other than age identified these sequences as “normal” or “abnormal” if they contained spike waves, discrete sharp waves or notched slow waves in the respective EEG period. ResultsEEGs of 297 children were analysed (three were omitted for technical reasons). 109 out of 297 EEGs (37%) had specific abnormalities supportive of a diagnosis of an epilepsy. 17 of these EEGs showed the abnormality in EEG sequences “B” or “C” and 7 (95% CI: 1.9–12.2) out of these demonstrated the abnormality in sequence “C” only. 105 out of 297 EEGs had non-specific findings. ConclusionWe conclude that reducing the recording time of standard EEGs to 15min may miss abnormalities in 2.36% [95% CI: 0.63–4.09%] overall and 6.42% [95% CI: 2.2–11.8%] of those with an abnormality supportive of an epilepsy to explain the reported symptoms. This result should inform any future discussions on seeking resource-efficiencies.

Magnetic resonance imaging abnormalities in children with epilepsy

The aim of this study is to analyze the proportional distribution of epilepsy and epileptic syndromes in children and to describe the magnetic resonance imaging (MRI) abnormalities found in these patients. Data from 457 children aged 1 month to 15 years at the time of diagnosis of epilepsy were recorded. A routine MRI has been requested in all patients with epilepsy at diagnosis according to a standardized pediatric seizure protocol. Abnormalities on MRI were classified as either significant or non-significant (standardized scoring system). International League Against Epilepsy criteria were used for diagnoses. The prevalence of significant MRI abnormalities was 21.9% (in infants 42.3%, in childhood 18.2%, and in adolescents 15.9%). The most common abnormalities included white-matter lesions (27.6%), volume loss (19.6%), gray-matter lesions (19.6%), and ventricular enlargement (12%). The use of MRI and a reliable standardized scoring system at diagnosis of epilepsy in children identified a high rate of significant abnormalities findings. This may have important implications for practice guidelines in this population.

Neurocardiogenic Syncope and Epilepsy in Pediatric Age

Neurocardiogenic syncope is induced by a hyperrecruitment of parasympathetic nerve tone elicited by emotional stress or pain. The presence of a transient loss of consciousness associated with involuntary motor activity or with urinary incontinence and the misinterpretation of anamnestic data or of electroencephalogram (EEG) abnormalities often leads to wrong diagnosis of epilepsy in children with this disorder.Careful and systematic history taking, pressure measurement, electrocardiogram (ECG), and, in selected cases, head-up tilt table testing are generally enough to rule out a cardiogenic or a neurocardiogenic syncope. Simultaneous EEG-ECG Holter represents a useful instrument for differential diagnosis between neurocardiogenic syncope and epilepsy.We report 3 case reports to demonstrate how simultaneous EEG-ECG Holter can contribute to characterize functional heart-brain interactions and the exact sequence of the physiopathologic events leading to the loss of consciousness in cases in which the clinical borders with epileptic disorders are particularly subtle.