Management Of Pediatric Epilepsy Research Articles

The effectiveness of MRI in the management of pediatric epilepsy at a tertiary care hospital in Taif, Saudi Arabia

BackgroundEpilepsy is one of the most common disorders, affecting over 50 million individuals globally, with an incidence rate of 8.8 per 10,000 in Saudi Arabia. The study aimed to look into structural abnormalities in children with epilepsy using magnetic resonance imaging (MRI). Materials and methodsThis study used a cross-sectional design. Performed between July 2021 and March 2023, 107 patients (under the age of 12) who presented with epilepsy at Children's Hospital in Taif were randomly sampled. ResultsThe patients' mean age was 2 years and 4 months. Males (69.2%) were impacted more frequently than females (30.8%). The majority of the patients' MRI results (75.7%) were negative, whereas 24.3% had positive results with identifiable abnormalities. Approximately 65.4% exhibited aberrant electroencephalogram findings, while 34.6% had normal findings. The majority of seizures were generalized (65.4%), with focal seizures accounting for 9.3%. The most common cause of epilepsy revealed with MRI was white matter disease (6.5%), followed by mesial temporal sclerosis (2.8%), hippocampal pathology (1.9%), and hydrocephalus (1.9%). Tuberous sclerosis, grey matter heterotopia, Sturge-Weber Syndrome, and schizencephaly were the infrequent neuroimaging findings (0.9%) in this investigation. ConclusionMRI is critical for accurately identifying and controlling epilepsy in pediatric patients, since it provides precise classifications that assist in treatment planning and prognosis.

Health Disparities in Pediatric Epilepsy: Methods and Lessons Learned.

Epilepsy affects 1% of youth and is associated with neurocognitive and psychosocial comorbidities, increased risk of mortality, and poor health-related outcomes. Health disparities in children and youth with epilepsy (CYE) have been understudied. A Special Interest Group (SIG) within the Pediatric Epilepsy Research Consortium is conducting a scoping review to systematically assess the literature and highlight the gaps in access to clinical care and management of pediatric epilepsy. The methodology for this review is presented. In conducting a peer-reviewed assessment of the scope of health disparities in pediatric epilepsy, we learned that developing the methodology for and conducting a comprehensive scoping review with multiple contributors resulted in a time-intensive process. While there is an evidence to suggest that health disparities do exist in CYE, very few studies have focused on these disparities. Disparity results are often not included in key elements of articles, lending them to be underemphasized and underrecognized. Preliminary conclusions inform several important research considerations.

Pediatric epilepsy care in Nigeria: A management approach for the primary care physicians

Epilepsy is a neurologic disorder of the brain characterized by an enduring predisposition to recurrent unprovoked seizures. It is the most common childhood neurologic disorder world-wide. Poor management often impacts negatively on the child's neurodevelopmental, emotional, physical, and social well-being. In resource-poor countries, the majority of children with epilepsy are managed by primary care physicians who are not sufficiently trained to offer effective care in pediatric epilepsy. Many low income countries do not have nationally approved guideline on management of pediatric epilepsy. Access to specialist care is costly and may involve long distance travels from rural areas to the cities. This often leads to a huge treatment gap. Efforts aimed at increasing the management skills of primary-care physicians in diagnosing and giving appropriate treatment is necessary in ensuring reduction in treatment gap. This review article is based on the authors' clinical experience and a review of 20 published works from review articles, recommendations, and guidelines sourced from PubMed and Google using the search terms “Paediatric epilepsy, management, primary care.” In the absence of any approved national guideline, a simplified approach to the clinical diagnosis, appropriate use of available diagnostic facilities, and cheap but cost-effective drugs will lead to better management of childhood epilepsy in resource-constrained settings.

Barriers, access and management of paediatric epilepsy with telehealth

Access to paediatric neurology care is complex, resulting in significant wait times and negative patient outcomes. The goal of the American Academy of Pediatrics National Coordinating Center for Epilepsy's project, Access Improvement and Management of Epilepsy with Telehealth (AIM-ET), was to identify access and management challenges in the deployment of telehealth technology. AIM-ET organised four paediatric neurology teams to partner with primary-care providers (PCP) and their multidisciplinary teams. Telehealth visits were conducted for paediatric epilepsy patients. A post-visit survey assessed access and satisfaction with the telehealth visit compared to an in-person visit. Pre/post surveys completed by PCPs and neurologists captured telehealth visit feasibility, functionality and provider satisfaction. A provider focus group assessed facilitators and barriers to telehealth. Sixty-one unique patients completed 75 telehealth visits. Paired t-test analysis demonstrated that telehealth enhanced access to epilepsy care. It reduced self-reported out-of-pocket costs (p<0.001), missed school hours (p<0.001) and missed work hours (p<0.001), with 94% equal parent/caregiver satisfaction. Focus groups indicated developing and maintaining partnerships, institutional infrastructure and education as facilitators and barriers to telehealth. Telehealth shortened travelling distance, reduced expenses and time missed from school and work. Further, it provides significant opportunity in an era when coronavirus disease 2019 limits in-person clinics.

Epilepsy-Work-Up and Management in Children.

Pediatric epilepsy is a highly variable condition due to age-related expression of syndromes that require specific diagnosis, evaluations, and treatments. Children with epilepsy differ from their adult counterparts in many important ways, mostly related to the age-related expression of specific epilepsy syndromes. This results in many important considerations related to the epilepsy diagnosis, classification, evaluations to determine an etiology, as well as treatment guidelines. A good understanding of these factors will help to establish an accurate epilepsy diagnosis, which in turn will guide appropriate testing and treatment decisions. In this way, patients will have improved seizure outcomes, and families will be educated appropriately and provided with the most accurate prognostic information available. The purpose of this article is to review the diagnosis, work-up, and management of pediatric epilepsy.

Reliability and availability of granger causality density in localization of Rolandic focus in BECTS.

A new method, called granger causality density (GCD), could reflect the directed information flow of the epileptiform activity, which is much closely match with excitatory and inhibitory imbalance theory of epilepsy. Here, we investigated if GCD could effectively localize the Rolandic focus in 50 patients with benign childhood epilepsy with central-temporal spikes (BECTS) from 27 normal children. The BECTS were classified into ictal epileptiform discharges (IEDs; 12 females, 15 males;age, 8.15 ± 1.68years) and non-IEDs (10 females, 13 males; age, 9.09 ± 1.98years) subgroups depending on the presence of central-temporal spikes. Multiple correlation-modality analyses (Pearson, across-voxel and across-subject correlations) were used to calculate the couplings between the GCD maps and IEDs-related brain activation map. The individual lateralization coefficient of localize IEDs and multiple regression analysis were used to identify the reliability of the GCD method in localizing the Rolandic focus. In this study, multiple correlation-modality analyses showed that the IEDs-related brain activation map and the GCD maps had highly temporal (coefficient ׀r\= 0.56 ~ 0.65) and spatial(\r\=0.53~0.91) (r\=~ couplings. The proposed GCD method and multiple regression analyses showed consistentfindings with the clinical EEG recordingsinlateralization of Rolandic focus. Furthermore, the GCD method could reflect the epilepsy-related brain activity during non-IEDs substate. Therefore, the proposed GCD method has the potential to be served as an effective and reliable neuroimaging biomarker to localize the Rolandic focus of BECTS. These findings are critical for clinical early diagnosis, and may promote the progression of treatment and management of pediatric epilepsy.

Neuroimaging in Pediatric Epilepsy.

Pediatric epilepsy presents with various diagnostic challenges. Recent advances in neuroimaging play an important role in the diagnosis, management and in guiding the treatment of pediatric epilepsy. Structural neuroimaging techniques such as CT and MRI can identify underlying structural abnormalities associated with epileptic focus. Functional neuroimaging provides further information and may show abnormalities even in cases where MRI was normal, thus further helping in the localization of the epileptogenic foci and guiding the possible surgical management of intractable/refractory epilepsy when indicated. A multi-modal imaging approach helps in the diagnosis of refractory epilepsy. In this review, we will discuss various imaging techniques, as well as aspects of structural and functional neuroimaging and their application in the management of pediatric epilepsy.

Laser Ablation Therapy for Pediatric Patients with Intracranial Lesions in Eloquent Areas

Laser interstitial thermal therapy (LITT) is an alternative, less-invasive, and, in some circumstances, effective treatment for patients with intracranial pathology including epilepsy and some tumors. For intracranial lesions in eloquent areas, resection by conventional craniotomy proves often to be a challenge, including in the care of pediatric patients. Herein, we reviewed our experience with magnetic resonance imaging (MRI)-guided LITT as treatment for pediatric patients with intracranial lesions in eloquent areas and evaluate neurologic function and clinical outcomes. We retrospectively reviewed consecutive patients with intracranial lesions in eloquent speech and motor areas who underwent MRI-guided LITT. Clinical evaluation, including neurologic function and neuropsychological testing, was conducted according to clinical considerations. MRI pre- and postoperative imaging was reviewed to compare the change of lesion size. Five pediatric patients received MRI-guided LITT of intracranial lesions in eloquent cortex. One patient experienced complications secondary to MRI-guided LITT, but neither was discharged with a neurologic deficit. For intracranial lesions in the eloquent cortex, conventional craniotomy with surgical resection is a challenge for neurosurgeons, especially pediatric patients. MRI-guided LITT provides a less-invasive and potentially effective option for treatment in the management of pediatric epilepsy and tumors.

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.

Challenges in the management of pediatric epilepsy in Nigeria

Epilepsy is a disorder that is associated with a lot of social stigma and diverse cultural beliefs as to its causation and management. Effective management often relies on the following: Clinical information obtained from the patient and corroborative eye-witness account/s; supportive ancillary laboratory investigations; use of appropriate drugs for sufficiently long periods; and adherence to the prescribed treatment. The valuable information and the supportive ancillary tests are often lacking in resource-poor countries, thus posing a lot of problems to the clinician managing epilepsy in these settings. This paper is based on the author's clinical experience and a review of relevant papers from 33 review articles sourced from PubMed using the search terms “pediatric epilepsy,” “management challenges/difficulties,” “sub-Saharan countries.” Practical solutions to overcome these difficulties are also proffered.

Updates in the medical management of pediatric epilepsy.

Epilepsy has been increasingly recognized as one of the most significant disorders facing humanity, with nearly 65 million people affected globally. One in 26 people will have epilepsy in their lifetime. It is a disease that has been documented in human history for millennia, and continues to be a diagnosis surrounded by fear, misunderstanding, and discrimination. The burden of epilepsy has unfortunately been placed disproportionately on individuals living in low and middle income countries, often leaving the most vulnerable with limited treatment options and access to care. Children also suffer more frequently from the disorder and face the additional challenges of disrupted cognitive and social development. Additionally, in the pediatric population, individuals with epilepsy face the challenging prospects of decreased academic achievement, lower quality of life, and higher mortality when compared to their unaffected peers.

Magnetoencephalography-guided resection of epileptogenic foci in children.

Resective surgery is increasingly used in the management of pediatric epilepsy. Frequently, invasive monitoring with subdural electrodes is required to adequately map the epileptogenic focus. The risks of invasive monitoring include the need for 2 operations, infection, and CSF leak. The aim of this study was to evaluate the feasibility and outcomes of resective epilepsy surgery guided by magnetoencephalography (MEG) in children who would have otherwise been candidates for electrode implantation. The authors reviewed the records of patients undergoing resective epilepsy surgery at the Hospital for Sick Children between 2001 and 2010. They identified cases in which resections were based on MEG data and no intracranial recordings were performed. Each patient's chart was reviewed for presentation, MRI findings, MEG findings, surgical procedure, pathology, and surgical outcome. Sixteen patients qualified for the study. All patients had localized spike clusters on MEG and most had abnormal findings on MRI. Resection was carried out in each case based on the MEG data linked to neuronavigation and supplemented with intraoperative neuromonitoring. Overall, 62.5% of patients were seizure free following surgery, and 20% of patients experienced an improvement in seizures without attaining seizure freedom. In 2 cases, additional surgery was performed subsequently with intracranial monitoring in attempts to obtain seizure control. MEG is a viable alternative to invasive monitoring with intracranial electrodes for planning of resective surgery in carefully selected pediatric patients with localization-related epilepsy. Good candidates for this approach include patients who have a well-delineated, localized spike cluster on MEG that is concordant with findings of other preoperative evaluations and patients with prior brain pathologies that make the implantation of subdural and depth electrodes somewhat problematic.

Abstract 624: Efficacy of KetoCal as an adjuvant therapy for malignant gliomas

Abstract The ketogenic diet (KD) is a high-fat, low-carbohydrate diet that alters the body's metabolism to burn fats in preference to carbohydrates. The use of fats as a primary energy source leads to a state of ketosis and the accumulation of ketone bodies in the blood. KetoCal (Nutricia North America, Gaithersburg, MD) is a nutritionally complete, commercially available 4:1 (fat: carbohydrate + protein) ketogenic formula that is an effective non-pharmacologic treatment for the management of pediatric epilepsy. Diet-induced changes to brain homeostasis as a result of ketosis have shown potential as an alternative treatment for other neurological diseases including malignant gliomas. We previously showed that Bio-Serv F3666 (Frenchtown, NJ), a rodent KD with a fat to carbohydrate + protein ratio of 6:1, potentiates the activity of both radiation and temozolomide (TMZ) therapy. We studied the efficacy of KetoCal as an adjuvant treatment for malignant glioma in combination with radiation or TMZ. GL261-luc cells expressing luciferase were stereotactically implanted into the right frontal lobe of albino C57BL/6 mice (NCI, Frederick, MD). Following intracranial implantation, animals were fed standard rodent chow (SD) and were randomized to treatment groups on day 3 (SD vs KetoCal with and without radiation or TMZ) based on bioluminescent signal (IVIS® Spectrum, Caliper Life Sciences, Hopkinton, MA). Blood levels of β-hydroxybutyrate (βHB) and glucose were measured using a Keto-Site reflectance meter (GDS Technologies, Elkhart, IN) and HemoCue Glucose System (HemoCue AB, Ängelholm, Sweden). βHB and glucose levels were checked one and two weeks following the initiation of diet treatment. Mice were maintained on a 12 hour light/dark cycle and KetoCal or SD was available ad libitum. Animals fed KetoCal had elevated levels of βHB (p=0.0173), decreased levels of glucose (p=0.0224) and increased median survival of approximately 6 days relative to animals on SD. To determine if KetoCal enhanced the effect of radiation; mice received 2 × 4 Gy whole brain radiation in combination with SD or KetoCal. Irradiated animals fed SD had a median survival of 44.5 days, while irradiated animals maintained on KetoCal demonstrated a complete loss of bioluminescence, suggesting the absence of viable tumor cells. These animals have been followed for &amp;gt;170 days with no visible signs of recurrent tumor (p=0.0061). Animals fed KetoCal in combination with TMZ (5×50mg/kg) had a median survival of 37 days compared to 28 days for animals treated with TMZ and maintained on SD (p=0.0043). In summary, the 4:1 fat: carbohydrate + protein ratio in KetoCal appears to provide a higher anti-tumor effect than a 6:1 formulation when used in addition to radiation or TMZ. The effect is particularly pronounced when used in combination with radiation. This suggests that cellular metabolic alterations brought about through changes in the diet may be useful for the treatment of human malignant gliomas. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 624. doi:10.1158/1538-7445.AM2011-624

The Challenge of Neuropsychiatric Issues in Pediatric Epilepsy

Diagnosis and management of pediatric epilepsy are challenging for a variety of reasons; however, one of the most common yet difficult situations involves treatment of the patient with pediatric epilepsy with coexistent cognitive impairment or psychiatric disturbance. The etiologies and presentations of these comorbidities are myriad, making diagnosis problematic; furthermore, interactions between epilepsy and its treatments and the neuropsychiatric problem and its treatments add another layer of complexity to the management of these patients. Antiepileptic drugs are often blamed for cognitive or behavioral problems in children treated for epilepsy, but the actual contribution to such problems in a particular child can be difficult to ascertain.