Seizure Disorders In Children Research Articles

Recommendations for the management of “febrile seizures” Ad hoc Task Force of LICE Guidelines Commission

Febrile seizures are the most common seizure disorder in childhood, affecting 2-5% of children. Simple febrile seizure is defined as a short (<15 min) generalized seizure, not recurring within 24 h, that occurs during a febrile illness not resulting from an acute disease of the nervous system in a child aged between 6 months and 5 years, with no neurologic deficits and no previous afebrile seizures. These recommendations address the instructions for management of the first febrile seizures, giving criteria for hospital admission, diagnosis, differential diagnosis, and treatment of a prolonged seizure. The authors stressed the benign prognosis of the majority of cases and the risk factors for recurrence of febrile seizures and appearance of epilepsy later on. Both continuous and intermittent anticonvulsant therapy are efficacious in preventing single febrile seizures, but side effects may be so important to overcome the benefits. These treatments are indicated in very selected patients.

Binge Drinking During Pregnancy and Risk of Seizures in Childhood: A Study Based on the Danish National Birth Cohort

Seizures are often found in children with fetal alcohol syndrome, but it is not known whether binge drinking during pregnancy by nonalcoholic women is associated with an increased risk of seizure disorders in children. The authors conducted a population-based cohort study of 80,526 liveborn singletons in the Danish National Birth Cohort (1996-2002). Information on maternal binge drinking (intake of > or = 5 drinks on a single occasion) was collected in 2 computer-assisted telephone interviews during pregnancy. Children were followed for up to 8 years. Information on neonatal seizures, epilepsy, and febrile seizures was retrieved from the Danish National Hospital Register. Results showed that exposure to binge drinking episodes during pregnancy was not associated with an increased risk of seizure disorders in children, except for those exposed at 11-16 gestational weeks. These children had a 3.15-fold increased risk of neonatal seizures (95% confidence interval: 1.37, 7.25) and a 1.81-fold increased risk of epilepsy (95% confidence interval: 1.13, 2.90). These findings suggest that maternal binge drinking during a specific time period of pregnancy may be associated with an increased risk of specific seizure disorders in the offspring. The results are exploratory, however, and need to be replicated.

Febrile Seizures: Clinical Practice Guideline for the Long-term Management of the Child With Simple Febrile Seizures

Febrile seizures are the most common seizure disorder in childhood, affecting 2% to 5% of children between the ages of 6 and 60 months. Simple febrile seizures are defined as brief (<15-minute) generalized seizures that occur once during a 24-hour period in a febrile child who does not have an intracranial infection, metabolic disturbance, or history of afebrile seizures. This guideline (a revision of the 1999 American Academy of Pediatrics practice parameter [now termed clinical practice guideline] "The Long-term Treatment of the Child With Simple Febrile Seizures") addresses the risks and benefits of both continuous and intermittent anticonvulsant therapy as well as the use of antipyretics in children with simple febrile seizures. It is designed to assist pediatricians by providing an analytic framework for decisions regarding possible therapeutic interventions in this patient population. It is not intended to replace clinical judgment or to establish a protocol for all patients with this disorder. Rarely will these guidelines be the only approach to this problem.

Cutaneous Manifestations of Seizure Disorder in Children—A Study of 100 Seizure Patients

Pediatric DermatologyVolume 24, Issue 5 p. 579-581 Cutaneous Manifestations of Seizure Disorder in Children—A Study of 100 Seizure Patients SUSHIL KAKKAR M.D., SUSHIL KAKKAR M.D. New Delhi, India e-mail: [email protected]Search for more papers by this authorVIBHU MENDIRATTA M.D., VIBHU MENDIRATTA M.D. New Delhi, India e-mail: [email protected]Search for more papers by this authorNEELU SHARMA M.D., NEELU SHARMA M.D. New Delhi, India e-mail: [email protected]Search for more papers by this authorSATINDER ANEJA M.D., SATINDER ANEJA M.D. New Delhi, India e-mail: [email protected]Search for more papers by this authorBHAWNA HARJAI M.D., D.N.B., BHAWNA HARJAI M.D., D.N.B. New Delhi, India e-mail: [email protected]Search for more papers by this author SUSHIL KAKKAR M.D., SUSHIL KAKKAR M.D. New Delhi, India e-mail: [email protected]Search for more papers by this authorVIBHU MENDIRATTA M.D., VIBHU MENDIRATTA M.D. New Delhi, India e-mail: [email protected]Search for more papers by this authorNEELU SHARMA M.D., NEELU SHARMA M.D. New Delhi, India e-mail: [email protected]Search for more papers by this authorSATINDER ANEJA M.D., SATINDER ANEJA M.D. New Delhi, India e-mail: [email protected]Search for more papers by this authorBHAWNA HARJAI M.D., D.N.B., BHAWNA HARJAI M.D., D.N.B. New Delhi, India e-mail: [email protected]Search for more papers by this author First published: 23 October 2007 https://doi.org/10.1111/j.1525-1470.2007.00534.xCitations: 3Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume24, Issue5September/October 2007Pages 579-581 RelatedInformation

Febrile Seizures

Febrile seizures are the most frequent of seizure disorders in childhood. Febrile seizures are most common in children between 6 months and 3 years of age, with a peak incidence at about 18 months. Approximately 30% to 40% of children who experience a febrile seizure will have a recurrence. The majority of febrile seizures occur within 24 hours of the onset of the fever. Febrile seizures can be simple or complex. Diagnostic studies are usually not necessary. Febrile seizures usually are self-limited, and intervention to stop the seizure often is unnecessary. When possible, the cause of the fever should be treated. Continuous preventative anticonvulsant therapy is not recommended for children with either simple or complex febrile seizures. The use of intermittent anticonvulsant therapy is not routinely indicated. Parental educational and counseling is important. The prognosis is excellent.

Ethnic Differences in the Incidence of Seizure Disorders in Children from Bradford, United Kingdom

We sought to determine if there are differences in the incidence of seizure disorders between the children of the indigenous and immigrant (predominantly Pakistani) populations of Bradford, United Kingdom. Annual incidence rates per 100,000 for new onset seizures were calculated along with Townsend deprivation scores. The incidence of seizures (including febrile and single) was 153 (95%CI 104-139). The rate was significantly higher in south Asians (SA) (220; 184-255) compared to non-south Asians (non-SA) (121; 104-139), mainly because of febrile seizures whose incidence was 87 (136-169) overall and 142 (114-170) and 61 (49-74) in SA and non-SA, respectively. There were no significant differences in the rates of nonfebrile seizures (non-FebSz) overall and of idiopathic non-FebSz between racial groups but the rate for symptomatic/cryptogenic non-FebSz was significantly higher in SA (22; 10-34) compared to non-SA (6; 2-10). The occurrence of seizure disorders correlated with social deprivation.

Panayiotopoulos syndrome: a consensus view

The aim of this paper is to promote the correct classification of, and provide guidelines on, the diagnosis and management of Panayiotopoulos syndrome (PS). An international consortium of established researchers in the field collaborated to produce a consensus document. The resulting document defines PS, characterizes its electro-clinical features, considers its likely pathogenesis, and provides guidance on appropriate management. We conclude that PS is a common idiopathic, benign seizure disorder of childhood, which should be classified as an autonomic epilepsy, rather than an occipital epilepsy.

Genome-wide linkage of febrile seizures and epilepsy to the FEB4 locus at 5q14.3-q23.1 and no MASS1 mutation

Febrile seizures (FS) represent the most common seizure disorder in childhood and contribution of a genetic predisposition has been clearly proven. In some families FS is associated with a wide variety of afebrile seizures. Generalized epilepsy with febrile seizures plus (GEFS+) is a familial epilepsy syndrome with a spectrum of phenotypes including FS, atypical febrile seizures (FS+) and afebrile generalized and partial seizures. Mutations in the genes SCN1B, SCN1A and GABRG2 were identified in GEFS+ families. GEFS+ is genetically heterogeneous and mutations in these three genes were detected in only a minority of the families. We performed a 10 cM density genome-wide scan in a multigenerational family with febrile seizures and epilepsy and obtained a maximal multipoint LOD score of 3.12 with markers on chromosome 5q14.3-q23.1. Fine mapping and segregation analysis defined a genetic interval of approximately 33 cM between D5S2103 and D5S1975. This candidate region overlapped with a previously reported locus for febrile seizures (FEB4) in the Japanese population, in which MASS1 was proposed as disease gene. Mutation analysis of the exons and exon-intron boundaries of MASS1 in our family did not reveal a disease causing mutation. Our linkage data confirm for the first time that a locus on chromosome 5q14-q23 plays a role in idiopathic epilepsies. However, our mutation data is negative and do not support a role for MASS1 suggesting that another gene within or near the FEB4 locus might exist.

A Possible Treatment for Pediatric Bipolar Disorder

Few effective treatments are known for pediatric mania (see Journal Watch Psychiatry May 18 2005). The anticonvulsant topiramate, which has a neutral effect on weight and a strong safety record for childhood seizure disorders, is a good candidate for study. These researchers randomized 56 children (mean age, 13.8) to receive topiramate (titrated by weight to …

Retrospective Study of the Use of Levetiracetam in Childhood Seizure Disorders

The purpose of this study was to assess the efficacy and safety of levetiracetam in a diverse pediatric epilepsy population. A retrospective chart review of 52 consecutive children age 8 months to 16 years who were treated with levetiracetam was performed. The data include patients with partial and generalized seizures, monotherapy, and concomitant antiepileptic drug use. Levetiracetam was dosed to efficacy or unacceptable side effects, with a range of 8 to 315 mg/kg/day. Two patients discontinued levetiracetam prior to assessment of efficacy owing to side effects. Of the remaining 50 patients, 12 had > or =75% seizure reduction, 3 had > or =50% and <75% seizure reduction, 8 had > or =25% and <50% seizure reduction, and 27 had < 25% seizure reduction. A variety of pediatric epilepsy syndromes and seizure types were represented. Adverse events, seen in 17 patients, were determined to be tolerable or resolved over time with continued dosing, dosage reduction, or discontinuation. This open-label, retrospective study of 52 consecutive pediatric patients treated with levetiracetam indicates at least partial efficacy in a variety of pediatric epilepsy syndromes. Tolerability was surprisingly favorable, even at doses far exceeding 40 mg/kg/day.

Turning on the heat

Febrile seizures (FS) occur in infancy or childhood and are associated with fever without evidence of intracranial infection or prior afebrile seizure. FS are the most common seizure disorder in children,1 affecting 2 to 5% of children by age 6 in the United States, and as many as 8.3% in Japan. After a first FS, children have a 25% to 40% recurrence risk. Genes clearly contribute to the risk of FS. FS are more common in relatives of individuals with a history of FS,2 and risks are consistently higher in monozygotic than dizygotic twins. A positive family history of FS is also a strong risk factor for FS recurrence.3 These data suggest that the predisposition to single FS and recurrence of FS are partially under genetic control. Risk for epilepsy is also increased after a first FS.4 Genetic heterogeneity is evident; recent genetic linkage studies in large pedigrees and nuclear families with FS have pointed to five chromosomal regions likely to harbor FS susceptibility genes (FEB1–FEB5; table 1).5–10⇓⇓⇓⇓⇓ Identification of the responsible genes in these regions is lacking, but has been …

Initial treatment of epilepsy with antiepileptic drugs

The selection of an antiepileptic drug (AED) for initial treatment of epilepsy in infancy, childhood, and adolescence should ideally be made after a clear syndromic diagnosis of the patient's seizure disorder. A common cause of failure of the first AED is erroneous diagnosis. The availability of new-generation AEDs has expanded the choice of available agents with comparable efficacy for most syndromes. Efficacy data based on class I or II evidence are not available for many syndromes of childhood, and selection must therefore be based on the best data available. It is also important to assess the relative toxicity and tolerability of AEDs in making the selection. It is especially important to appreciate age-specific organ toxicities. Moreover, the use of AEDs in childhood requires an understanding of their neurobehavioral effects. Important neuropsychiatric co-morbidities in children with epilepsy include attention deficit/hyperactivity disorder, autistic spectrum disorders, depression and anxiety, and thought disorders. These problems can be exacerbated or ameliorated by specific AEDs. The effect of AEDs on body weight, insulin sensitivity, lipid profile, and bone health is becoming better appreciated. Newer AEDs may offer significant advantages in this regard. Co-morbid migraine in children with epilepsy may benefit from some AEDs. There remains a continuing need for the development of newer AEDs that are targeted for the developing brain to improve the efficacy and tolerability of treatment in childhood seizure disorders.

Refractory atypical absence seizures in rat: a two hit model

Medically refractory seizure disorders in children usually have malignant neurodevelopmental outcomes and often are associated with the presence of congenital cortical dysplasias in the brain. To date, there are no animal models of these disorders by which to test hypotheses of pathogenesis or to screen novel drugs for antiepileptic activity. In rats, treatment with the antimitotic agent methylazoxymethanol acetate (MAM) on gestational day (G) 15 produces a neuronal migration disorder similar to the cortical dysplasias seen in human brain. We sought to produce chronic, recurrent, medically refractory seizures by administration of the cholesterol biosynthesis inhibitor AY-9944 (AY) during postnatal development in rats exposed prenatally to MAM. Prenatal MAM and postnatal AY treatments resulted in spontaneous, recurrent atypical absence seizures that were characterized by bilaterally synchronous slow spike-and-wave discharges (SWD) with a frequency of 6 Hz. The MAM–AY-induced seizures were refractory to ethosuximide, sodium valproate, and the GABA BR antagonist CGP 35348, and were exacerbated by carbamazepine. Histological examination of brains from MAM-treated rats showed hippocampal heterotopias, in addition to atrophy and abnormalities of cortical lamination. The MAM–AY-treated rat represents a reproducible model of refractory atypical absence seizures in children with brain dysgenesis.

Computed tomography and childhood seizure disorder in Ibadan.

Computed Tomography (CT) is an important tool for neuroimaging, it offers an opportunity to investigate structural lesions as a cause of seizures with little morbidity. This study is designed to evaluate it's applicability in children with epileptic seizures. It is a descriptive study of the CT scans of the 103 consecutive children who were referred to the CT suite of the University College Hospital on account of seizure disorders over a 5 year period (1997--2001). Only 103 (4.6%) of the subjects who had cranial scans done in five years were children with seizures disorders. The CT scans were abnormal in 53 (51.5 %). Hydrocephalus was the most common finding in 14 (13.6%). Cerebral atrophy and infarct were reported in 10.6% and 8.7% respectively. The outlined cranial fractures found in 6.8% were all depressed. A high incidence (74.4%) of abnormal scans was reported in the children with partial seizures. Thirty-three (62.3%) of the abnormal scans were amenable to surgery. The presence of neurologic deficit increased the yield of abnormal CT features. CT scans are of extreme value in the screening and definitive evaluation of seizures in children. It is advocated for excluding treatable conditions and monitoring progression of the disorder.

A Clinical Guide to Epileptic Syndromes and their Treatment: Based on the New ILAE Diagnostic Scheme

A Clinical Guide to Epileptic Syndromes and their Treatment: Based on the New ILAE Diagnostic Scheme

Dose–, Time–, Age–, and Sex–Response Profiles for the Anticonvulsant Effects of Deoxycorticosterone in 15-Day-Old Rats

Recently, we have shown that a single high dose of the adrenal steroid precursor hormone deoxycorticosterone (DOC) has potent anticonvulsant effects in 15-day-old rats. To better define the actions of DOC, the present study established dose–, time–, age–, and sex–response curves for the anticonvulsant actions of DOC. Methods. Dose– and time–response studies were done using two different seizure models: (1) maximal pentylenetetrazol seizures (MMT) and (2) maximal electroconvulsive shock (MES) seizures. Subsequently, age– and sex–response studies were done using MMT seizures and two different DOC doses, one low (nonsedating) and one high (sedating). Results. In dose–response studies, DOC suppressed MMT seizures with an ED50 of about 5 mg/kg (sc). Higher doses were necessary to suppress MES seizures, where the ED50 was about 20 mg/kg. In time–response studies, DOC's effects were rapid in onset. Complete suppression of seizures was seen by 5 min in the MES model and by 15 min in the MMT model. In developmental studies, both a low nonsedating and a high sedating dose of DOC suppressed MMT seizures in neonatal, infant, weanling, and juvenile rats of either sex. The suppressive effects of low-dose DOC were lost after puberty, however. The suppressive effects of high-dose DOC also declined after puberty, especially in males. Conclusion. DOC has significant anticonvulsant actions that occur in prepubertal, but not postpubertal subjects. DOC might have clinical importance in the future treatment of childhood seizure disorders.

Epileptiform abnormalities in children with attention-deficit-hyperactivity disorder

The proportion of children with attention-deficit-hyperactivity disorder and epileptiform abnormalities is compared with an historic control group of normal school-aged children. The medical records of 655 children 5-16 years of age referred to a single pediatric neurologist (M.S.) from January 1991 to December 1999 with school problems, behavior problems, or hyperactivity were retrospectively reviewed. Clinical criteria for attention-deficit-hyperactivity disorder were satisfied in 476 of these children. An electroencephalogram was obtained from 347 patients and coded as epileptiform in 6.1 ± 1.3%, which is significantly higher (chi-square test, P < 0.025) than the prevalence rate of 3.5 ± 0.6% observed in a study of 3,726 normal school-aged children [1]. The epileptiform abnormality was present only with activation procedures in six of our patients (hyperventilation [n = 2] and photic stimulation [n = 4]). Only three of the 21 children with epileptiform abnormalities developed a seizure disorder in our cohort. We conclude that the prevalence rate of epileptiform abnormalities is greater in children with attention-deficit-hyperactivity disorder compared with that observed in normal school-aged children when hyperventilation and photic stimulation are used. However, the clinical utility of routine electroencephalography in the diagnosis of a comorbid seizure disorder in children with attention-deficit-hyperactivity disorder is limited.

New-onset absence status epilepsy presenting as altered mental status in a pediatric patient

Absence status epilepsy (ASE) is an uncommon seizure disorder in children. The primary presentation of new-onset ASE in a pediatric patient is an unusual cause of altered mental status in the emergency department. We describe a previously healthy 8-year-old child who presented with an acutely altered mental state. The patient was awake but confused, with a fluctuating level of alertness and an inability to perform simple routine tasks. The results of general physical and neurologic examination, with the exception of mental status, were normal. Head computed tomography and laboratory test results were normal. Electroencephalographic testing revealed seizure activity consistent with ASE. Administration of intravenous diazepam caused cessation of seizure activity and a return to the patient’s baseline mental function. Although rare, ASE should be considered in the differential diagnosis of altered mental status in children. [Benson PJ, Klein EJ. New-onset absence status epilepsy presenting as altered mental status in a pediatric patient. Ann Emerg Med. April 2001;37:402-405.]

The role of vigabatrin in childhood seizure disorders: results from a clinical audit.

The emergence of visual field defects attributed to vigabatrin (VGB) treatment and intramyelinic edema in animal experiments has raised concerns about its future role in the treatment of childhood seizures. We evaluated our experience with this antiepileptic agent with retrospective analysis of database and chart audit. Of 73 patients, 43 girls and 33 boys were treated with VGB over a 7-year period. The mean age of patients at the introduction of VGB was 87 months (range, 5-257 months). In 12 of 73 cases, VGB was used as monotherapy; in 61 of 73 cases, it was used as an add-on drug. Seizure types included secondarily generalized seizures (21), mixed seizures (21), partial seizures (18), and generalized seizures (13). Seizure etiology was idiopathic/cryptogenic in 22 patients, symptomatic in 50, and undetermined in a single patient. The mean duration of therapy was 16 months (median, 10 months; range, 1-144 months). VGB was effective in 30 (seven seizure free, 23 with >90% reduction in seizures), partially effective in four (50-90% reduction in seizures), and ineffective in 38 (<50% reduction in seizures). Nearly 50% of patients with infantile spasms responded to VGB. All patients underwent ophthalmic evaluation; two (16%) of 12 patients who could undergo static threshold perimetry were demonstrated to have the characteristic visual field constriction. VGB is effective in producing a significant reduction in seizure frequency in nearly half the patients with childhood seizures, including refractory epilepsy. Despite emerging concerns regarding visual side effects, this drug retains an important role in the medical management of childhood epilepsy.

Inheritance of Photosensitivity

To investigate the mode of inheritance of the photoparoxysmal response (PPR) and to obtain more information about the influence of photosensitivity on the seizure risk in siblings of patients with epilepsy. Examination of the records of families with one photosensitive parent (Group I, n = 54) and of families with a photosensitive proband, neither of whose parents was photosensitive (Group II, n = 72). At the age of maximum penetrance, between 5 and 15 years of age, 50% of the siblings in Group I were photosensitive, compared to only 15% in Group II. Siblings in Group I showed a higher seizure rate (19%) than siblings in Group II (4%, p < 0.005). The majority of photosensitive siblings had no seizures, but photosensitive siblings had a higher seizure risk than non-photosensitive siblings. The highest seizure risk was found in photosensitive siblings of Group I (33%) compared to 9% in non-photosensitive siblings (p < 0.05). Our findings show that a PPR in parents is a major determinant for the risk of a PPR in offspring. The results may indicate an autosomal-dominant transmission with age-dependent penetrance of the PPR. Photosensitivity is an important factor in the pathogenesis of seizure disorders in childhood.