Management Of Epilepsy In Children Research Articles

Adapted Evidence-Based Clinical Practice Guidelines for Diagnosis and Treatment of Epilepsies in Children: A Tertiary Children's Hospital Update

Hypothesis and/or BackgroundWe recently updated and merged the adapted clinical practice guidelines (CPGs) for the diagnosis and treatment of children with epilepsy of a tertiary-level hospital. Medical knowledge is always evolving. As a result, it is critical to revisit the clinical standards on a frequent basis to ensure that the best services are offered to the target receivers. The purpose of this article was to update and merge the CPGs at Alexandria University Children Hospital (AUCH) for the diagnosis (2014) and treatment (2016) of children with epilepsy to unify and standardize the practice for better care and outcome. MethodsThis review and update CPG project was initiated by assembling a Guideline Review Group (GRG). The GRG conducted focus group discussions and decided to search any published updates of the recommendations of the previously identified high-quality and evidence-based CPG developed by the SIGN (Scottish Intercollegiate Guidelines Network) and to merge the two previous local CPGs under one comprehensive CPG for full management of epilepsy in children. The high quality of the selected source CPG from SIGN was based on quality assessment of CPGs undertaken previously using the Appraisal of Guidelines for Research and Evaluation II Instrument. The GRG followed the Checklist for the Reporting of Updated Guidelines (CheckUp), which is the CPG tool recommended by the Enhancing the Quality and Transparency of health Research Network for reporting of updated CPGs in addition to the RIGHT-Ad@pt Checklist for Adapted CPGs. The finalized updated CPG draft was sent to the external reviewer group topic experts. ResultsThe group updated 10 main categories of recommendations from one source CPG (SIGN). The recommendations included (1) epilepsy diagnosis; (2) recognition, identification, and referral; (3) pharmacological treatment of epilepsy and epilepsy syndromes; (4) nonpharmacological treatment of epilepsy and epilepsy syndromes; (5) managing pharmacoresistant epilepsy; (6) management of epilepsy in special groups; (7) medications; (8) children and caregiver education and support; (9) comorbidities and mortality; and (10) transitional care from pediatric to adult care services. ConclusionsThe finalized CPG provides evidence-based guidance to health care providers in AUCH for the diagnosis and management of epilepsy in children. The study also established the significance of a collaborative clinical and methodological expert group for the update of CPGs, as well as the usability of the “CheckUp” and “RIGHT-Ad@pt” CPG Tools.

A Review of the Prevalence, Etiology, Diagnosis, and Management of Pediatric Epilepsies in India

AbstractPediatric seizures are one of the most common neurological manifestations seen in pediatrics. Unravelling the etiology, timely and appropriate investigations followed by suitable therapies are essential for improving quality of life. During the pandemic, focused group discussions were conducted among 50 pediatric neurologists across five cities in India to gather insights on treatment practices in pediatric epilepsy and to optimize therapeutic strategies and alternative approaches for rational use of antiepileptic medications. These discussions were mainly aimed at reviewing current literature on prevalence, etiology, diagnosis, and management of epilepsy in children and subsequently rationalizing diagnostic and treatment approaches in routine clinical practice. Epileptic encephalopathies comprise of childhood epilepsy with progressive cerebral dysfunction. Genomics plays a vital role in identifying the underlying genetic associations, empowering precision therapy. Currently, the ketogenic diet has become a well-recognized modality for reducing severity of seizures. To overcome the high incidence of adverse effects due to older antiepileptic drugs, newer drugs are being developed to improve ease of use, diminish drug interactions, decrease adverse effects, and identify drugs with unique mechanisms of action. Common lacunae in practice include information gaps, educating parents, or caregivers about rational drug use and ensuring compliance to antiepileptic medications. This article discussed the consensus clinical viewpoint of expert clinicians, as well as insights on optimized treatment of pediatric epilepsies in both infancy and childhood. It also discusses aspects, like reducing drug burden, emerging therapies in the identification of the genetic basis of epilepsies, and targeted therapy alternatives, for pediatric populations in the Indian scenario.

Using Sodium Valproate in Children <2 Years of Age: Study in a District Hospital, Dinajpur, Bangladesh

Introduction: Sodium valproate is proposed for addition to the Model List of Essential Medicines, for use in the management of epilepsy in children. This is effective in treating many seizure types, like a generalized tonic-clonic seizure, myoclonic seizure, absence seizure, in other epilepsy syndromes like an infantile spasm, Landau-Kleffner syndrome (LKS), etc. Aim of the study: This study aimed to observe the side effects caused by sodium valproate in children below 2 years of age. Methodology: An observational study was conducted in the Department of Paediatric M Abdur Rahim Medical College (MARMC), Dinajpur, Bangladesh, during the period of January 2019 to December 2019. Sixty (60) children Results: Male were dominated the gender distribution and were 54% and female were 46%. A maximum of 46% of patients was diagnosed with epilepsy between 6-12 months, Out of the total studied patients, the maximum 44% started sodium valproate ages between 7-12 months. Among the total studied patients 40% took 26-30mg/kg/day sodium valproate as their treatment regime. A total of 16% had anemia among the studied patients, whereas for the rest 84% of patients no other symptoms were found during their general examination. Among the total studied patients, the most dominating side effect of the patients was vomiting which resulted in 1/5th (20%) of all side effects. The side effects of both hair loss and loss of appetite show the same result of 10% for each whereas, only 4% and 2% had abdominal pain and weight gain respectively. Conclusion: In this study vomiting was found as the most significant side effect which similar to other different studies also. These findings may be helpful for future researchers in further research. It was a single centered study with a small-sized sample.

Flipped classroom versus traditional lecture in training undergraduates in pediatric epilepsy.

Introduction:Pedagogical constructs such as flipped classroom are used to engage students in the learning process by their active participation. The aim of the present study was to compare the two models of flipped classroom and traditional lecture in training undergraduates in pediatric epilepsy.Methods:The study was conducted among the 3rd-year undergraduate medical students. They were divided to either of Group I or II. Pediatric epilepsy was taught in two parts (clinical diagnosis and management). Group I received Part A as traditional lecture and Part B as the flipped classroom and the reverse for Group II. The difference in posttest and pretest scores was compared between two groups for each part.Results:There was a significant increase in posttest scores when compared to pretest scores in both the groups. Mean (standard deviation [SD]) difference in scores for epilepsy diagnosis was comparable in Group I (3.33 [2.3]) and Group II (2.46 [2.17]) (P = 0.16). Mean (SD) difference in scores for epilepsy management was significantly higher in Group I (3.41 [2.09]) when compared to Group II (1.30 [1.84]) (P < 0.01).Conclusion:Flipped classroom model resulted in better scores than the traditional teaching method for training undergraduates in the management of epilepsy in children. This teaching–learning method could be adopted in training of primary care physicians.

Antiepileptic drugs for the management of epilepsy in children under 5 years with tuberous sclerosis complex

Antiepileptic drugs for the management of epilepsy in children under 5 years with tuberous sclerosis complex

General Principles of the Medical Management of Epilepsy in Children: A Literature Review

The primary aim of epilepsy treatment is seizure control, and the treatment is principally prophylactic. Although complete seizure control is the most important predictor of improved quality of life, antiepileptic drugs (AEDs) could cause severe side effects in the patients. Therefore, the risk-benefit ratio must be considered before the initiation of AED treatment. Accurate recognition and differentiation of epileptic and non-epileptic paroxysmal events and the diagnosis of the seizure type and epilepsy syndrome are essential procedures before AED treatment. It is often recommended that AED treatment start after two seizures, and being seizure-free for a minimum of two years is a prerequisite for treatment withdrawal. The AED treatment process must be initiated with a single drug at a low maintenance dose, along with further upward titration. Overall, the first attempt in AED treatment has been reported to effectively control seizures in 50-70% of the cases. Moreover, there is a consensus that being seizure-free for two years is the most valid approach to discontinue AED treatment. Approximately 50% of the children with epilepsy outgrow their disease. The present study aimed to provide a systematic method for the treatment and management of epilepsy in children.

The management of epilepsy in children and adults.

The International League Against Epilepsy has recently published a new classification of epileptic seizures and epilepsies to reflect the major scientific advances in our understanding of the epilepsies since the last formal classification 28 years ago. The classification emphasises the importance of aetiology, which allows the optimisation of management. Antiepileptic drugs (AEDs) are the main approach to epilepsy treatment and achieve seizure freedom in about two-thirds of patients. More than 15 second generation AEDs have been introduced since the 1990s, expanding opportunities to tailor treatment for each patient. However, they have not substantially altered the overall seizure-free outcomes. Epilepsy surgery is the most effective treatment for drug-resistant focal epilepsy and should be considered as soon as appropriate trials of two AEDs have failed. The success of epilepsy surgery is influenced by different factors, including epilepsy syndrome, presence and type of epileptogenic lesion, and duration of post-operative follow-up. For patients who are not eligible for epilepsy surgery or for whom surgery has failed, trials of alternative AEDs or other non-pharmacological therapies, such as the ketogenic diet and neurostimulation, may improve seizure control. Ongoing research into novel antiepileptic agents, improved techniques to optimise epilepsy surgery, and other non-pharmacological therapies fuel hope to reduce the proportion of individuals with uncontrolled seizures. With the plethora of gene discoveries in the epilepsies, "precision therapies" specifically targeting the molecular underpinnings are beginning to emerge and hold great promise for future therapeutic approaches.

Ketogenic Diet for the Management of Epilepsy Associated with Tuberous Sclerosis Complex in Children.

Background and PurposeIn the present study, we reviewed the outcome of ketogenic diet (KD) use for the management of epilepsy in children with tuberous sclerosis complex (TSC).MethodsA total of 12 children with intractable epilepsy associated with TSC who were treated with KD at our hospital between March 1, 2008 and February 28, 2015 were retrospectively enrolled.ResultsThe mean age at the time of KD initiation was 73.1 ± 38.0 months. Patients were medically refractory to a mean of 4.8 ± 1.7 antiepileptic drugs. Nine patients (75.0%) had a history of infantile spasms. At 3 months after KD initiation, 10 patients (83.3%) had > 50% seizure reduction. Moreover, 7 patients (58.3%) exhibited qualitative improvements in cognition and behavior after KD initiation, as reported by caregivers/parents. The mean duration of dietary therapy was 14.8 ± 12.8 months. Half of the patients in this study eventually underwent epilepsy surgery due to persistent seizures or seizure relapse.ConclusionKD is an important non-pharmacological treatment option for patients with intractable epilepsy associated with TSC. KD may improve cognition and behavior in addition to reducing seizure frequency.

Comparative Effect of Divided Doses of Adult Solid and Liquid Oral Formulations of Antiepileptic Drugs in the Management of Pediatric Epilepsy

Objective:To compare the differences in the efficacy and safety of the commonly prescribed AEDs in the management of epilepsy in children when using divided doses of adult solid oral formulations (DDSF) with the liquid oral formulations (LFs).Materials and Methods:Patients who had one or more seizures per month and prescribed with DDSF were recruited. Initially the patients were continued on DDSF for 4 months following which they were switched over to LF for the subsequent 4 months. Seizure frequencies and adverse drug effects (ADRs) were recorded every month for 8 months and plasma AED levels were estimated at the end of 4th and 8th months.Results:A total of 200 patients completed the study protocol. The median seizure frequencies per month with DDSF and LF were: partial seizures (20.5, 9.0; P < 0.001), generalized tonic-clonic seizures (6.5, 2.0; P < 0.001), myoclonic seizures (58.5, 29.0; P < 0.001). Mean plasma drug levels ± SD (μg/ml) with DDSF and LF were: sodium valproate (48.2 ± 13.7, 69.1 ± 16.3; P < 0.001), phenytoin sodium (5.0 ± 2.4, 12.8 ± 3.8; P < 0.001), carbamazepine (4.5 ± 2.0, 11.5 ± 4.8; P < 0.001) and phenobarbitone (14.1 ± 5.2, 25.4 ± 12.3, P < 0.001). The incidence of treatment emergent ADRs was poor scholastic performance (25.5%), behavioral problems and dizziness/sedation (21.0%), somnolence/sleep disorders (19.5%).Conclusion:Patients treated with LF had better seizure control and optimal therapeutic drug levels and less adverse effects when compared to DDSF.

Childhood epilepsies: What should a pediatrician know?

Seizures in children are among the most common neurological disorders. A pediatrician should know how to approach a child who presents with a seizure. This review will focus on points that are important in the evaluation of children who have experienced seizures. A comprehensive and neurologically focused framework for history taking and a thorough clinical examination are the cornerstones in diagnosing and managing seizures. This article reviews the clinical approach to the diagnosis, investigation, and management of epilepsy in children, excluding neonatal seizures. A pediatrician should also be aware of common epilepsy syndromes that occur in children such as Benign Childhood Epilepsy with Centro-Temporal Spikes, and childhood absence epilepsy.

AN AUDIT OF THE MANAGEMENT OF EPILEPSY IN CHILDREN AND YOUNG PEOPLE WITH INTELLECTUAL DISABILITIES

ObjectiveTo assess the management of epilepsy in children and young people with intellectual disabilities, against quality standards published by the National Institute for Health and Care Excellence (NICE) and the...

Role of SPECT and PET in pediatric epilepsy

Single photon emission computed tomography (SPECT) and positron emission tomography (PET) offer valuable information for the diagnosis, management, and follow up of patients with seizure disorders. These imaging studies can also contribute to the understanding of the pathophysiology of epilepsy. Intractable epilepsy in children is a serious disorder that has an overwhelming effect on physical, psychological, and social development. Functional imaging with PET and SPECT has been useful in a variety of seizure types and is typically more sensitive compared to anatomic imaging methods such as magnetic resonance imaging for localizing non-lesional seizure foci. SPECT and PET may be useful in guiding the strategy of implantation in patients submitted to undergo invasive recordings. However, the ability of PET and SPECT to localize a seizure focus may be crucial for tailoring the surgical resection area in patients with intractable seizures. Since most seizure cases begin in childhood, PET and SPECT imaging for seizure disorders is frequently used in this population. In this article, we review the literature on the current uses and indications of PET and SPECT in the study and management of epilepsy in children.

P.7.f.006 Sleep quality, school grades and quality of life in Italian adolescents

Results: The mean score of the total HRQOL was 152.16±17.95. From the stepwise regression analysis of the eight subscales score of CBCL, the final model emerged with social problems, delinquent behavior, and maternal education as predictors that explain 41.5% of the variation in the total HRQOL score. Social problems of eight subscales of CBCL was the most influential predictor on the HRQOL score, accounting for 30.6% of the variance. Conclusions: This study shows that social problems and delinquent behavior have the powerful impact on the HRQOL in children and adolescents with epilepsy. Therefore, the management of epilepsy in children and adolescents should involve the evaluation and intervention of possible behavior problems such as especially, social problems and delinquent behavior to improve their QOL.

Rational Management of Epilepsy

Management of epilepsies in children has improved considerably over the last decade, all over the world due to the advances seen in the understanding of the patho-physiology of epileptogenesis, availability of both structural and functional imaging studies along with better quality EEG/video-EEG recordings and the availability of a plethora of newer anti-epileptic drugs which are tailormade to act on specific pathways. In spite of this, there is still a long way to go before one is able to be absolutely rational about which drug to use for which type of epilepsy. There have been a lot of advances in the area of epilepsy surgery and is certainly gaining ground for specific cases. Better understanding of the genetic basis of epilepsies will hopefully lead to a more rational treatment plan in the future. Also, a lot of work needs to be done to dispel various misunderstandings and myths about epilepsy which still exists in our country.

Exome sequencing reveals new causal mutations in children with epileptic encephalopathies

The management of epilepsy in children is particularly challenging when seizures are resistant to antiepileptic medications, or undergo many changes in seizure type over time, or have comorbid cognitive, behavioral, or motor deficits. Despite efforts to classify such epilepsies based on clinical and electroencephalographic criteria, many children never receive a definitive etiologic diagnosis. Whole exome sequencing (WES) is proving to be a highly effective method for identifying de novo variants that cause neurologic disorders, especially those associated with abnormal brain development. Herein we explore the utility of WES for identifying candidate causal de novo variants in a cohort of children with heterogeneous sporadic epilepsies without etiologic diagnoses. We performed WES (mean coverage approximately 40×) on 10 trios comprised of unaffected parents and a child with sporadic epilepsy characterized by difficult-to-control seizures and some combination of developmental delay, epileptic encephalopathy, autistic features, cognitive impairment, or motor deficits. Sequence processing and variant calling were performed using standard bioinformatics tools. A custom filtering system was used to prioritize de novo variants of possible functional significance for validation by Sanger sequencing. In 9 of 10 probands, we identified one or more de novo variants predicted to alter protein function, for a total of 15. Four probands had de novo mutations in genes previously shown to harbor heterozygous mutations in patients with severe, early onset epilepsies (two in SCN1A, and one each in CDKL5 and EEF1A2). In three children, the de novo variants were in genes with functional roles that are plausibly relevant to epilepsy (KCNH5, CLCN4, and ARHGEF15). The variant in KCNH5 alters one of the highly conserved arginine residues of the voltage sensor of the encoded voltage-gated potassium channel. In vitro analyses using cell-based assays revealed that the CLCN4 mutation greatly impaired ion transport by the ClC-4 2Cl(-) /H(+) -exchanger and that the mutation in ARHGEF15 reduced GEF exchange activity of the gene product, Ephexin5, by about 50%. Of interest, these seven probands all presented with seizures within the first 6 months of life, and six of these have intractable seizures. The finding that 7 of 10 children carried de novo mutations in genes of known or plausible clinical significance to neuronal excitability suggests that WES will be of use for the molecular genetic diagnosis of sporadic epilepsies in children, especially when seizures are of early onset and difficult to control.

Neurosurgical management of intractable rolandic epilepsy in children: role of resection in eloquent cortex

Neurosurgical management of intractable rolandic epilepsy in children: role of resection in eloquent cortex

Management of epilepsy in children with autism

Summary Epilepsy is a major cause of morbidity in autism. The diagnosis and management of epilepsy in autism is complicated by a high prevalence of co-morbid neurodevelopmental disorders and co-medication. The prevalence of epilepsy is highest in those autistic children with cognitive, motor and receptive language difficulties. The underlying pathophysiology of Autism, its high rate of paroxysmal electroencephalographic abnormalities and its association with epilepsy is debated. Suggestions regarding the appropriate investigation and management of autistic children presenting with possible epilepsy are outlined.

7.The Neurosurgical Management of Epilepsy in Children : The Hospital for Sick Children Experience(PS-4 Epilepsy Surgery:Creating New, Learning from Old,The 26^&lt;th&gt; Annual Meeting of The Japanese Congress of Neurological Surgeons)

7.The Neurosurgical Management of Epilepsy in Children : The Hospital for Sick Children Experience(PS-4 Epilepsy Surgery:Creating New, Learning from Old,The 26^&lt;th&gt; Annual Meeting of The Japanese Congress of Neurological Surgeons)

Surgical Treatment of Epilepsy in Children

Learning Objectives: After reading this article, the participant should be able to: List the general indications for surgical management of epilepsy in children. Describe briefly the common procedures in epilepsy surgery. Discuss the risks and benefits of different surgical procedures in treatment of epilepsy in children.

What is new in paediatric epilepsy?

There are many recent advances in the understanding and management of epilepsy in children. Epidemiological data support the requirement for two or more unprovoked seizures for the diagnosis. New epilepsy syndromes abound as magnetic resonance imaging has uncovered new causative brain malformations with important implications for counseling and treatment. Molecular genetics has uncovered the basic mechanisms for several epilepsy syndromes. Indications for new drugs are slowly being defined, while nonmedication treatments for intractable patients have been further developed (ketogenic diet, vagus nerve stimulation, cortical resection). Clinical studies show that the chance of long-term remission can be predicted fairly accurately for many children. Death from childhood epilepsy is exceedingly rare. Despite these gains, the social outcome in adulthood is often unsatisfactory.